Healthcare Provider Details

I. General information

NPI: 1982113403
Provider Name (Legal Business Name): AMBER HAYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 GENERAL MOUTON AVE
LAFAYETTE LA
70501-8511
US

IV. Provider business mailing address

227 MARTIN OAKS DR
LAFAYETTE LA
70501-2505
US

V. Phone/Fax

Practice location:
  • Phone: 337-232-9457
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: