Healthcare Provider Details

I. General information

NPI: 1326830704
Provider Name (Legal Business Name): ADAZIA DIANE AUBRE KINCHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADAZIA DIANE AUBRE KINCHEN

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 01/03/2026
Certification Date: 01/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2114 LARIMORE AVE
OMAHA NE
68110-1422
US

IV. Provider business mailing address

2114 LARIMORE AVE
OMAHA NE
68110-1422
US

V. Phone/Fax

Practice location:
  • Phone: 402-612-1536
  • Fax:
Mailing address:
  • Phone: 402-612-1536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: