MEDICARE: KIARA JAMILETH GONZALEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant	3747P1801X

General Provider Information

NPI Number	:	1548986136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIARA JAMILETH GONZALEZ

Provider Business Mailing Address
First Line	:	9607 BINNEY ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68134-4617
Country	:	US
Telephone Number	:	402-615-3162
Fax Number	:

Provider Business Practice Location Address
First Line	:	19065 GEORGE MILLER PKWY
Second Line	:
City	:	ELKHORN
State	:	NE
Zip	:	68022-2977
Country	:	US
Telephone Number	:	402-615-3162
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2022
Last Update Date	:	03/18/2026

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