Healthcare Provider Details

I. General information

NPI: 1114897774
Provider Name (Legal Business Name): ANA PAULA HAYES AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 N STATE ST STE 502
JACKSON MS
39202-2414
US

IV. Provider business mailing address

1190 N STATE ST STE 502
JACKSON MS
39202-2414
US

V. Phone/Fax

Practice location:
  • Phone: 601-944-1781
  • Fax: 601-353-0439
Mailing address:
  • Phone: 601-944-1781
  • Fax: 601-353-0439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number907351
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number907351
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: