Provider Demographics
NPI:1104392620
Name:HASTY, KAYLA RAE (CNA, DDMAT, MAT, HHA)
Entity Type:Individual
Prefix:MISS
First Name:KAYLA
Middle Name:RAE
Last Name:HASTY
Suffix:
Gender:F
Credentials:CNA, DDMAT, MAT, HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DESKIN DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-8295
Mailing Address - Country:US
Mailing Address - Phone:405-701-8530
Mailing Address - Fax:405-701-8531
Practice Address - Street 1:3400 DESKIN DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-8295
Practice Address - Country:US
Practice Address - Phone:405-701-8530
Practice Address - Fax:405-701-8531
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator