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NPI Code Detail

MEDICARE: DR. KEITH BRYAN HAYNIE DNP, RN, CFNP

MEDICARE: DR. KEITH BRYAN HAYNIE DNP, RN, CFNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerR45728NM
2363LP0808XPsychiatric/Mental Health Nurse PractitionerCNP01098NM

General Provider Information

NPI Number : 1033355284
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEITH BRYAN HAYNIE DNP, RN, CFNP
Provider Business Mailing Address
First Line : PO BOX 1595
Second Line :
City : MIDDLETOWN
State : CT
Zip : 06457-8095
Country : US
Telephone Number : 860-788-6404
Fax Number : 860-398-6441
Provider Business Practice Location Address
First Line : 206 S CORONADO AVE
Second Line :
City : ESPANOLA
State : NM
Zip : 87532-2792
Country : US
Telephone Number : 860-788-6404
Fax Number : 860-398-6441
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2008
Last Update Date : 04/30/2024

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