1922005545 NPI number — SUSAN CRAIG HAYNES A.P.N.

Table of content: SUSAN CRAIG HAYNES A.P.N. (NPI 1922005545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922005545 NPI number — SUSAN CRAIG HAYNES A.P.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAYNES
Provider First Name:
SUSAN
Provider Middle Name:
CRAIG
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
A.P.N.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALLEN
Provider Other First Name:
SUSAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
A.P.N.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922005545
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3215 STECK AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78757-7566
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-476-3556
Provider Business Mailing Address Fax Number:
512-476-0195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3215 STECK AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78757-7566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-476-3556
Provider Business Practice Location Address Fax Number:
512-476-0195
Provider Enumeration Date:
06/29/2005

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: 363LG0600X , with the licence number:  570847 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 570847 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0928954-03 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".