Healthcare Provider Details

I. General information

NPI: 1295532182
Provider Name (Legal Business Name): JAKEYIA BOGARD
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11635 ARBOR ST
OMAHA NE
68144-5000
US

IV. Provider business mailing address

4317 N 54TH ST
OMAHA NE
68104-2819
US

V. Phone/Fax

Practice location:
  • Phone: 402-506-9368
  • Fax:
Mailing address:
  • Phone: 402-810-2334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number100227
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: