=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659244929
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DESHAWN A BARNES
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2025
-----------------------------------------------------
Last Update Date | 09/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1033 E 23RD ST STE 7
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68025-2448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-721-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1202 E 14TH ST
-----------------------------------------------------
City | WAYNE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68787-1247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-375-2880
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 373H00000X
-----------------------------------------------------
Taxonomy Name | Day Training/Habilitation Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------