Healthcare Provider Details

I. General information

NPI: 1215333406
Provider Name (Legal Business Name): CARRIE MARIE HAYES MHS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2014
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6958 SW VARNS STREET
PORTLAND OR
97223-8281
US

IV. Provider business mailing address

6958 SW VARNS STREET
PORTLAND OR
97223-8281
US

V. Phone/Fax

Practice location:
  • Phone: 503-683-7730
  • Fax: 503-914-0927
Mailing address:
  • Phone: 503-683-7730
  • Fax: 503-914-0927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberPA09389
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberPA58062
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number58062
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA58062
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA208577
License Number StateOR
# 7
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA208577
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: