Healthcare Provider Details

I. General information

NPI: 1821906215
Provider Name (Legal Business Name): JASON BOYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 N 63RD ST
OMAHA NE
68104-3352
US

IV. Provider business mailing address

2910 N 63RD ST
OMAHA NE
68104-3352
US

V. Phone/Fax

Practice location:
  • Phone: 402-502-3513
  • Fax:
Mailing address:
  • Phone: 402-502-3513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: