Provider Demographics
NPI:1588462311
Name:HAYNES-FULLER, NAKEISHA
Entity type:Individual
Prefix:
First Name:NAKEISHA
Middle Name:
Last Name:HAYNES-FULLER
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 1:1347 Y ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-3562
Mailing Address - Country:US
Mailing Address - Phone:402-679-9305
Mailing Address - Fax:
Practice Address - Street 1:1347 Y ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-3562
Practice Address - Country:US
Practice Address - Phone:402-679-9305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide