MEDICARE: MELISSA KIM HAYNIE BA

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1669731774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA KIM HAYNIE BA

Provider Business Mailing Address
First Line	:	PO BOX 890968
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73189-0968
Country	:	US
Telephone Number	:	405-837-8526
Fax Number	:

Provider Business Practice Location Address
First Line	:	321 E KITTYHAWK DR
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-5309
Country	:	US
Telephone Number	:	405-837-8526
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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