MEDICARE: CASEY LEE HAYNES

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	163WM0705X	Medical-Surgical Registered Nurse	95095315	CA

General Provider Information

NPI Number	:	1598610552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY LEE HAYNES

Provider Business Mailing Address
First Line	:	7995 STONE CANYON CIR
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-4001
Country	:	US
Telephone Number	:	530-448-6652
Fax Number	:

Provider Business Practice Location Address
First Line	:	7995 STONE CANYON CIR
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-4001
Country	:	US
Telephone Number	:	530-448-6652
Fax Number	:

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

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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