Active NPI
Matthew Kisicki
- Home Health Registered Nurse
- Omaha, NE
National Provider Identifier
1912895079
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Registered Nurse
- License
- 85950
- Practice address
- 3000 S 84TH St
Omaha, NE 68124-3215 - Phone
- (402) 955-7777
- NPI assigned
- Jun 26, 2025
- Sex
- Male
- 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 Registered Nurse | 163WH0200X | 85950 | NE | Primary |
Addresses
Primary practice location
3000 S 84TH St
Omaha, NE 68124-3215
Mailing address
2707 N 207TH St
Elkhorn, NE 68022-1287
Phone (402) 981-4623
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 85950 | NE | MD | Home Health Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1750896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750896000000",
"number": "1912895079",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2707 N 207TH ST",
"city": "ELKHORN",
"state": "NE",
"postal_code": "680221287",
"telephone_number": "402-981-4623"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3000 S 84TH ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681243215",
"telephone_number": "402-955-7777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KISICKI",
"first_name": "MATTHEW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-06-26",
"last_updated": "2025-06-26",
"certification_date": "2025-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "163WH0200X",
"taxonomy_group": "",
"desc": "Registered Nurse, Home Health",
"state": "NE",
"license": "85950",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 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.