MEDICARE: KELSEY HAYNES CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1-139002	AL

General Provider Information

NPI Number	:	1366339194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY HAYNES CRNP

Provider Business Mailing Address
First Line	:	551 TRIPLE CREEK DR
Second Line	:
City	:	MORRIS
State	:	AL
Zip	:	35116-1738
Country	:	US
Telephone Number	:	205-370-5744
Fax Number	:

Provider Business Practice Location Address
First Line	:	2038 SPRINGDALE LN
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35217-2028
Country	:	US
Telephone Number	:	205-841-7665
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2025
Last Update Date	:	06/23/2025

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