Healthcare Provider Details

I. General information

NPI: 1275899197
Provider Name (Legal Business Name): BETHANY ALEXANDER HAYNES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 ROGERSVILLE RD
RADCLIFF KY
40160-9344
US

IV. Provider business mailing address

PO BOX 2119
ELIZABETHTOWN KY
42702-2119
US

V. Phone/Fax

Practice location:
  • Phone: 270-351-2323
  • Fax: 270-351-8031
Mailing address:
  • Phone: 270-351-2323
  • Fax: 270-351-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number48995
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number48995
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: