Healthcare Provider Details

I. General information

NPI: 1639082621
Provider Name (Legal Business Name): MRS. KELSEY COLLEEN LEIDEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5606 S 147TH ST
OMAHA NE
68137-2648
US

IV. Provider business mailing address

5606 S 147TH ST
OMAHA NE
68137-2648
US

V. Phone/Fax

Practice location:
  • Phone: 402-715-8200
  • Fax:
Mailing address:
  • Phone: 402-715-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number138011
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: