1679580278 NPI number — HELEN BERNICE HAYES FNP-BC, PMHNP-BC

Table of content: HELEN BERNICE HAYES FNP-BC, PMHNP-BC (NPI 1679580278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679580278 NPI number — HELEN BERNICE HAYES FNP-BC, PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAYES
Provider First Name:
HELEN
Provider Middle Name:
BERNICE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC, PMHNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOYD
Provider Other First Name:
HELEN
Provider Other Middle Name:
BERNICE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP, PMHNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679580278
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 79254
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28271-7061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-234-2594
Provider Business Mailing Address Fax Number:
855-313-5068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 UNIONVILLE INDIAN TRAIL RD W
Provider Second Line Business Practice Location Address:
SUITE A-1
Provider Business Practice Location Address City Name:
INDIAN TRAIL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28079-5583
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-234-2594
Provider Business Practice Location Address Fax Number:
855-313-5068
Provider Enumeration Date:
08/03/2006

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: 363L00000X , with the licence number:  201021 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 201021 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7005792 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com