Provider Demographics
NPI:1124139761
Name:HAYES, CHARITY A (ARNP)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:A
Last Name:HAYES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 N 9TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-3909
Mailing Address - Country:US
Mailing Address - Phone:515-574-6890
Mailing Address - Fax:
Practice Address - Street 1:115 S PARK AVE
Practice Address - Street 2:
Practice Address - City:EAGLE GROVE
Practice Address - State:IA
Practice Address - Zip Code:50533-2219
Practice Address - Country:US
Practice Address - Phone:515-448-5185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-094133363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA-094133OtherLICENSE
IAA-094133OtherLICENSE