Active NPI
Latisha Clark
- Home Health Aide
- Bellevue, NE
National Provider Identifier
1104797802
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Aide
- Practice address
- 12901 S 29TH PL
Bellevue, NE 68123-3218 - Phone
- (402) 312-8029
- NPI assigned
- Sep 15, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | Primary |
Addresses
Primary practice location
12901 S 29TH PL
Bellevue, NE 68123-3218
Mailing address
12901 S 29TH PL
Bellevue, NE 68123-3218
Phone (402) 312-8029
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1757894400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757894400000",
"number": "1104797802",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12901 S 29TH PL",
"city": "BELLEVUE",
"state": "NE",
"postal_code": "681233218",
"telephone_number": "402-312-8029"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12901 S 29TH PL",
"city": "BELLEVUE",
"state": "NE",
"postal_code": "681233218",
"telephone_number": "402-312-8029"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "LATISHA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-09-15",
"last_updated": "2025-09-15",
"certification_date": "2025-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bellevue, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.