Healthcare Provider Details

I. General information

NPI: 1316855091
Provider Name (Legal Business Name): KYLIE JO MUMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11550 BURKE ST APT 5
OMAHA NE
68154-3177
US

IV. Provider business mailing address

11550 BURKE ST APT 5
OMAHA NE
68154-3177
US

V. Phone/Fax

Practice location:
  • Phone: 402-556-1883
  • Fax:
Mailing address:
  • Phone: 402-556-1883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: