1164776126 NPI number — MRS. ASHLEY O'BARR HAYNES CPNP-AC

Table of content: MRS. ASHLEY O'BARR HAYNES CPNP-AC (NPI 1164776126)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164776126 NPI number — MRS. ASHLEY O'BARR HAYNES CPNP-AC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAYNES
Provider First Name:
ASHLEY
Provider Middle Name:
O'BARR
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CPNP-AC
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:
1164776126
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5705 UPTAIN RD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37411-5613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-266-6918
Provider Business Mailing Address Fax Number:
423-265-0620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5705 UPTAIN RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37411-5613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-266-6918
Provider Business Practice Location Address Fax Number:
423-265-0620
Provider Enumeration Date:
10/30/2012

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: 363LP0200X , with the licence number:  APN17068 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com