Provider Demographics
NPI:1609765668
Name:MCCLETON, TYRAN
Entity type:Individual
Prefix:
First Name:TYRAN
Middle Name:
Last Name:MCCLETON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 CUMING ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2022
Mailing Address - Country:US
Mailing Address - Phone:402-612-9309
Mailing Address - Fax:
Practice Address - Street 1:6010 WENNINGHOFF RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-1903
Practice Address - Country:US
Practice Address - Phone:402-979-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide