Healthcare Provider Details

I. General information

NPI: 1568439602
Provider Name (Legal Business Name): CATHERINE HAYNES CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 10/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23453 CENTRAL DRIVE
SAUCIER MS
39574-7521
US

IV. Provider business mailing address

12261 HIGHWAY 49 STE 11
GULFPORT MS
39503-2976
US

V. Phone/Fax

Practice location:
  • Phone: 228-832-7223
  • Fax: 228-374-0856
Mailing address:
  • Phone: 228-374-2494
  • Fax: 228-374-2713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR789598
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR789598
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: