Provider Demographics
NPI:1063204006
Name:BARNES, KEONNA CHALETE
Entity type:Individual
Prefix:
First Name:KEONNA
Middle Name:CHALETE
Last Name:BARNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5917 FONTENELLE BLVD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-1141
Mailing Address - Country:US
Mailing Address - Phone:402-707-4434
Mailing Address - Fax:
Practice Address - Street 1:5917 FONTENELLE BLVD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-1141
Practice Address - Country:US
Practice Address - Phone:402-707-4434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-17
Last Update Date:2025-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider