Provider Demographics
NPI:1710111562
Name:HAYES, KENESHA NICOE (LPN)
Entity Type:Individual
Prefix:MS
First Name:KENESHA
Middle Name:NICOE
Last Name:HAYES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3573 MOTTS PLACE CT
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-9693
Mailing Address - Country:US
Mailing Address - Phone:614-424-0256
Mailing Address - Fax:
Practice Address - Street 1:3573 MOTTS PLACE CT
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-9693
Practice Address - Country:US
Practice Address - Phone:614-424-0256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 134364 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse