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NPI Code Detail

MEDICARE: KEAIRRA HAYNES

MEDICARE:   KEAIRRA  HAYNES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker111560TX

General Provider Information

NPI Number : 1730955386
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEAIRRA HAYNES
Provider Business Mailing Address
First Line : 21201 EMERALD MIST PKWY APT 328
Second Line :
City : SPRING
State : TX
Zip : 77379-1538
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3000 S HULEN ST STE 124-2042
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-1929
Country : US
Telephone Number : 817-975-5623
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/27/2023
Last Update Date : 11/27/2023

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Directions to “ KEAIRRA HAYNES ” Practice Location

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