Healthcare Provider Details

I. General information

NPI: 1578648580
Provider Name (Legal Business Name): KRISTY LYNN HAYES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 BELLEVIEW AVE SE EMERGENCY DEPARTMENT 1 SOUTH
ROANOKE VA
24014-1838
US

IV. Provider business mailing address

1906 BELLEVIEW AVE EMERGENCY DEPARTMENT 1 SOUTH
ROANOKE VA
24014-0000
US

V. Phone/Fax

Practice location:
  • Phone: 540-266-6331
  • Fax: 540-981-9550
Mailing address:
  • Phone: 540-266-6331
  • Fax: 540-981-9550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110002393
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: