Provider Demographics
NPI:1891252342
Name:HANES, NIKEYA
Entity Type:Individual
Prefix:
First Name:NIKEYA
Middle Name:
Last Name:HANES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NIKEYA
Other - Middle Name:
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 GATEHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-8874
Mailing Address - Country:US
Mailing Address - Phone:214-226-4550
Mailing Address - Fax:
Practice Address - Street 1:201 GATEHOUSE DR
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-8874
Practice Address - Country:US
Practice Address - Phone:214-226-4550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2062820225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant