MEDICARE: KERRI HAYES

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1629337746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRI HAYES

Provider Business Mailing Address
First Line	:	13317 S OAK HILLS PKWY
Second Line	:	UNIT 1DR
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-2738
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13317 S OAK HILLS PKWY
Second Line	:	UNIT 1DR
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-2738
Country	:	US
Telephone Number	:	773-750-6043
Fax Number	:

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

Provider Enumeration Date	:	05/09/2012
Last Update Date	:	05/09/2012

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