Healthcare Provider Details

I. General information

NPI: 1922743665
Provider Name (Legal Business Name): SHAYNNA HAYES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 GROOM RD
BAKER LA
70714-4336
US

IV. Provider business mailing address

6420 GROOM RD
BAKER LA
70714-4336
US

V. Phone/Fax

Practice location:
  • Phone: 225-412-2781
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number223915
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: