Provider Demographics
NPI:1154076503
Name:HAYES, ANDREA (APRN-CNP)
Entity type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 SE 11TH STREET
Mailing Address - Street 2:
Mailing Address - City:ANADARKO
Mailing Address - State:OK
Mailing Address - Zip Code:73005
Mailing Address - Country:US
Mailing Address - Phone:405-247-9500
Mailing Address - Fax:405-247-9505
Practice Address - Street 1:412 SE 11TH STREET
Practice Address - Street 2:
Practice Address - City:ANADARKO
Practice Address - State:OK
Practice Address - Zip Code:73005
Practice Address - Country:US
Practice Address - Phone:405-247-9500
Practice Address - Fax:405-247-9505
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144182363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK201150820AMedicaid