Healthcare Provider Details

I. General information

NPI: 1083536338
Provider Name (Legal Business Name): TYRONE OGLESBY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7805 L ST
OMAHA NE
68127-1855
US

IV. Provider business mailing address

10511 PRATT PLZ
OMAHA NE
68134-3414
US

V. Phone/Fax

Practice location:
  • Phone: 531-375-1013
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: