Healthcare Provider Details

I. General information

NPI: 1902855257
Provider Name (Legal Business Name): KRISTIE D HAYES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4014 LEAVENWORTH ST
OMAHA NE
68105-1053
US

IV. Provider business mailing address

988102 NEBRASKA MEDICAL CTR
OMAHA NE
68198-8102
US

V. Phone/Fax

Practice location:
  • Phone: 402-552-7928
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number18245
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: