Healthcare Provider Details

I. General information

NPI: 1194641613
Provider Name (Legal Business Name): MELODYE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 N 60TH AVE
OMAHA NE
68104-4058
US

IV. Provider business mailing address

7200 S 84TH ST
LA VISTA NE
68128-2115
US

V. Phone/Fax

Practice location:
  • Phone: 712-326-8910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: