Provider Demographics
NPI:1437958998
Name:KELLY, TONI R
Entity type:Individual
Prefix:MISS
First Name:TONI
Middle Name:R
Last Name:KELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3802 N 60TH ST # N60TH
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-2749
Mailing Address - Country:US
Mailing Address - Phone:531-777-3360
Mailing Address - Fax:
Practice Address - Street 1:3802 N 60TH ST # N60TH
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-2749
Practice Address - Country:US
Practice Address - Phone:531-777-3360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty