1770760688 NPI number — MS. AVIS ELAINE HAYNES PHD RN CNM FPNP

Table of content: MS. AVIS ELAINE HAYNES PHD RN CNM FPNP (NPI 1770760688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770760688 NPI number — MS. AVIS ELAINE HAYNES PHD RN CNM FPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAYNES
Provider First Name:
AVIS
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PHD RN CNM FPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770760688
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 N STATE STREET
Provider Second Line Business Mailing Address:
UNIV OF MS MEDICAL CENTER OB-GYN DEPT
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-815-7300
Provider Business Mailing Address Fax Number:
601-815-7355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 NORTH STATE STREET
Provider Second Line Business Practice Location Address:
WINFRED WISER WOMENS HOSPITAL
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-815-7300
Provider Business Practice Location Address Fax Number:
601-815-7355
Provider Enumeration Date:
01/23/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367A00000X , with the licence number:  R537985 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)