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General NPI Number Information
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NPI Number | 1902530058
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Entity Type | Individual
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Provider Name | CARLY JO MORAN
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Gender | Female
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Dates
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Enumeration Date | 07/14/2022
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 42ND AND EMILE
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City | OMAHA
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State | NE
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Zip | 68198-0001
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Country | US
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Telephone | 402-559-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 1337 W WHITECHURCH LN
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City | SIOUX FALLS
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State | SD
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Zip | 57108-3322
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3049
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License Number State | NE
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