Healthcare Provider Details

I. General information

NPI: 1730012857
Provider Name (Legal Business Name): KEONNA D HEPBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6025 HARTMAN AVE
OMAHA NE
68104-1153
US

IV. Provider business mailing address

7237 N 71ST AVE
OMAHA NE
68152-2127
US

V. Phone/Fax

Practice location:
  • Phone: 402-620-8685
  • Fax:
Mailing address:
  • Phone: 402-620-8685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: