Provider Demographics
NPI:1124827092
Name:GALES, KEYADA
Entity type:Individual
Prefix:
First Name:KEYADA
Middle Name:
Last Name:GALES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8273 CRAIG AVE # OMAHANE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-1279
Mailing Address - Country:US
Mailing Address - Phone:402-714-3841
Mailing Address - Fax:
Practice Address - Street 1:8273 CRAIG AVE # OMAHANE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-1279
Practice Address - Country:US
Practice Address - Phone:402-714-3841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE149765374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide