MEDICARE: MRS. LAUREN ASHLEY HAYWARD

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	363A00000X	Physician Assistant
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1972387058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAUREN ASHLEY HAYWARD

Provider Business Mailing Address
First Line	:	4132 S CINCINNATI AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-3810
Country	:	US
Telephone Number	:	405-626-6290
Fax Number	:

Provider Business Practice Location Address
First Line	:	4132 S CINCINNATI AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-3810
Country	:	US
Telephone Number	:	405-626-6290
Fax Number	:

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

Provider Enumeration Date	:	08/21/2023
Last Update Date	:	08/21/2023

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