Healthcare Provider Details

I. General information

NPI: 1417184680
Provider Name (Legal Business Name): ASHLEY M R HAYNES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 N MAIN ST
WICHITA KS
67203-3608
US

IV. Provider business mailing address

1518 E KALISPELL CT
ANDOVER KS
67002-7982
US

V. Phone/Fax

Practice location:
  • Phone: 316-617-0680
  • Fax:
Mailing address:
  • Phone: 252-864-5790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number04-42127
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number04-42127
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04-42127
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP9873
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number04-42127
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: