Healthcare Provider Details

I. General information

NPI: 1538094024
Provider Name (Legal Business Name): EIBHLIN KELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8902 N 81ST AVE
OMAHA NE
68122-2238
US

IV. Provider business mailing address

8902 N 81ST AVE
OMAHA NE
68122-2238
US

V. Phone/Fax

Practice location:
  • Phone: 402-937-2051
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number177794
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: