=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578968632
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA HAYES RN FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2014
-----------------------------------------------------
Last Update Date | 04/18/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 S PALESTINE ST
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75751-3325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-262-8292
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 118
-----------------------------------------------------
City | EUSTACE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75124-0118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-262-8292
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 449098
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------