Provider Demographics
NPI:1891585501
Name:HARNESS, HAYDEN ALEXIS
Entity type:Individual
Prefix:
First Name:HAYDEN
Middle Name:ALEXIS
Last Name:HARNESS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:HAYDEN
Other - Middle Name:ALEXIS
Other - Last Name:KIMBERLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1519 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-6239
Mailing Address - Country:US
Mailing Address - Phone:479-670-3275
Mailing Address - Fax:
Practice Address - Street 1:471688 SH-51
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960
Practice Address - Country:US
Practice Address - Phone:918-696-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program