=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467326744
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALIYAH HAYNES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2025
-----------------------------------------------------
Last Update Date | 10/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 535 S EMPORIA AVE STE 103
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67202-4534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-841-6861
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 E MAIN ST
-----------------------------------------------------
City | SPRING ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49283-9701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-750-6684
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 84893
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------