Healthcare Provider Details

I. General information

NPI: 1457263865
Provider Name (Legal Business Name): NICHOLE HAYES CPSP, CPSPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 S CALHOUN ST
FORT WAYNE IN
46807-1408
US

IV. Provider business mailing address

215 3RD ST
FORT WAYNE IN
46808-2751
US

V. Phone/Fax

Practice location:
  • Phone: 260-908-3167
  • Fax:
Mailing address:
  • Phone: 260-600-9442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: