Healthcare Provider Details

I. General information

NPI: 1467311407
Provider Name (Legal Business Name): TRACE TITSWORTH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 S 50TH ST STE 213
OMAHA NE
68117-1355
US

IV. Provider business mailing address

4601 S 50TH ST STE 213
OMAHA NE
68117-1355
US

V. Phone/Fax

Practice location:
  • Phone: 402-339-1602
  • Fax:
Mailing address:
  • Phone: 402-339-1602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: