Provider Demographics
NPI:1316419641
Name:HAYMORE, JARED LAVELL (PA-C)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:LAVELL
Last Name:HAYMORE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 E HIGHWAY 90 STE 200
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-9113
Mailing Address - Country:US
Mailing Address - Phone:520-263-3500
Mailing Address - Fax:520-263-3599
Practice Address - Street 1:5750 E HIGHWAY 90 STE 200
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-9113
Practice Address - Country:US
Practice Address - Phone:520-263-3500
Practice Address - Fax:520-263-3599
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7381363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical