Healthcare Provider Details

I. General information

NPI: 1992092134
Provider Name (Legal Business Name): TIA AUSTIN HAYES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIA A. HAYES

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N. STATE STREET DIVISION OF NEPHROLOGY
JACKSON MS
39216-4609
US

IV. Provider business mailing address

2500 N. STATE STREET
JACKSON MS
39216-4609
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5687
  • Fax: 601-984-5765
Mailing address:
  • Phone: 601-815-6496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR867941
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: