MEDICARE: CLIFTON LYTLE JR.

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	374U00000X	Home Health Aide		NE

General Provider Information

NPI Number	:	1598699126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLIFTON LYTLE JR.

Provider Business Mailing Address
First Line	:	4611 S 96TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68127-1202
Country	:	US
Telephone Number	:	531-375-0895
Fax Number	:

Provider Business Practice Location Address
First Line	:	4611 S 96TH ST STE 292
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68127-1256
Country	:	US
Telephone Number	:	531-375-0895
Fax Number	:	531-375-0895

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

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/09/2026

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Directions to “ CLIFTON LYTLE JR. ” Practice Location

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