Healthcare Provider Details

I. General information

NPI: 1467448878
Provider Name (Legal Business Name): KIMBERLY L HAYES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 HARTFORD TPKE STE M
VERNON CT
06066-5044
US

IV. Provider business mailing address

520 HARTFORD TPKE STE M
VERNON ROCKVILLE CT
06066-5044
US

V. Phone/Fax

Practice location:
  • Phone: 860-872-8321
  • Fax: 860-812-0306
Mailing address:
  • Phone: 860-871-8321
  • Fax: 860-875-6271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number000195
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: