Provider Demographics
NPI:1962372250
Name:FREEMAN, KANEISHA NICOLE
Entity type:Individual
Prefix:
First Name:KANEISHA
Middle Name:NICOLE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2885 YELLOW PINE CT APT 2
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-3454
Mailing Address - Country:US
Mailing Address - Phone:904-210-1481
Mailing Address - Fax:
Practice Address - Street 1:2885 YELLOW PINE CT APT 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-3454
Practice Address - Country:US
Practice Address - Phone:904-210-1481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-11
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician