Healthcare Provider Details

I. General information

NPI: 1215791686
Provider Name (Legal Business Name): KIMBERLY ANN VAUGHAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY ANN DIZONA RN

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 N 51ST ST STE 200
OMAHA NE
68132-2831
US

IV. Provider business mailing address

119 N 51ST ST STE 200
OMAHA NE
68132-2831
US

V. Phone/Fax

Practice location:
  • Phone: 402-932-8020
  • Fax: 402-905-3042
Mailing address:
  • Phone: 402-932-8020
  • Fax: 402-905-3042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number114328
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: