1659611416 NPI number — MRS. DANIELLE RENEE HAYES PA-C

Table of content: MRS. DANIELLE RENEE HAYES PA-C (NPI 1659611416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659611416 NPI number — MRS. DANIELLE RENEE HAYES PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAYES
Provider First Name:
DANIELLE
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TUCKER
Provider Other First Name:
DANIELLE
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659611416
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3232 N NORTHHILLS BLVD
Provider Second Line Business Mailing Address:
HIGHLANDS ONCOLOGY GROUP
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72703-4005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-587-1700
Provider Business Mailing Address Fax Number:
479-587-1366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
808 S 52ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROGERS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72758-8602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-443-4500
Provider Business Practice Location Address Fax Number:
479-443-4502
Provider Enumeration Date:
02/15/2013

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: 363A00000X , with the licence number:  PA-518 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 199679795 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200506480A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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