MEDICARE: KORTNEY HAYNES CVD

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
1	174H00000X	Health Educator
2	374J00000X	Doula

General Provider Information

NPI Number	:	1215746250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KORTNEY HAYNES CVD

Provider Business Mailing Address
First Line	:	PO BOX 104422
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65110-4422
Country	:	US
Telephone Number	:	573-797-6327
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 104422
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65110-4422
Country	:	US
Telephone Number	:	573-797-6327
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2025
Last Update Date	:	01/03/2025

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