Healthcare Provider Details

I. General information

NPI: 1285598581
Provider Name (Legal Business Name): KENNETH WAYTES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4265 MAPLE ST
OMAHA NE
68111-3466
US

IV. Provider business mailing address

1299 FARNAM ST
OMAHA NE
68102-1880
US

V. Phone/Fax

Practice location:
  • Phone: 531-999-4440
  • Fax:
Mailing address:
  • Phone: 531-999-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: