Healthcare Provider Details

I. General information

NPI: 1861034605
Provider Name (Legal Business Name): STEPHANIE J HAYES ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2019
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S 2ND AVE
WALLA WALLA WA
99362-4118
US

IV. Provider business mailing address

PO BOX 32
LIBERTY LAKE WA
99019-0032
US

V. Phone/Fax

Practice location:
  • Phone: 509-897-3700
  • Fax: 509-897-5575
Mailing address:
  • Phone: 866-747-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00171949
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61034032
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61034032
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: