1104392620 NPI number — MISS KAYLA RAE HASTY CNA, DDMAT, MAT, HHA

Table of content: MISS KAYLA RAE HASTY CNA, DDMAT, MAT, HHA (NPI 1104392620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104392620 NPI number — MISS KAYLA RAE HASTY CNA, DDMAT, MAT, HHA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASTY
Provider First Name:
KAYLA
Provider Middle Name:
RAE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
CNA, DDMAT, MAT, HHA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104392620
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3400 DESKIN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORMAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73069-8295
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-701-8530
Provider Business Mailing Address Fax Number:
405-701-8531

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3400 DESKIN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORMAN
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73069-8295
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-701-8530
Provider Business Practice Location Address Fax Number:
405-701-8531
Provider Enumeration Date:
10/23/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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