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NPI Code Detail

MEDICARE: MRS. WANDA MARIE HAYNES FNP-C

MEDICARE: MRS. WANDA MARIE HAYNES FNP-C
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 Practitioner111047NE
2363LF0000XFamily Nurse Practitioner726951TX
3363LF0000XFamily Nurse PractitionerAP07135LA
4363LF0000XFamily Nurse PractitionerA-123907IA
5363LF0000XFamily Nurse Practitioner2019040422MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
147428OTHERNEBCBS NE

General Provider Information

NPI Number : 1235329764
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. WANDA MARIE HAYNES FNP-C
Provider Business Mailing Address
First Line : 9411 N OAK TRFY STE LL1
Second Line :
City : KANSAS CITY
State : MO
Zip : 64155-2262
Country : US
Telephone Number : 816-691-1655
Fax Number :
Provider Business Practice Location Address
First Line : 9411 N OAK TRFY STE 205
Second Line :
City : KANSAS CITY
State : MO
Zip : 64155-2229
Country : US
Telephone Number : 816-691-3546
Fax Number : 816-346-7474
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2007
Last Update Date : 12/11/2023

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