Provider Demographics
NPI:1487255105
Name:HAYES, JEFFREY W
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:W
Last Name:HAYES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 182
Mailing Address - Street 2:
Mailing Address - City:VERNER
Mailing Address - State:WV
Mailing Address - Zip Code:25650-0182
Mailing Address - Country:US
Mailing Address - Phone:304-583-8027
Mailing Address - Fax:
Practice Address - Street 1:108 AMBER ROAD
Practice Address - Street 2:
Practice Address - City:MALLORY
Practice Address - State:WV
Practice Address - Zip Code:25634
Practice Address - Country:US
Practice Address - Phone:304-583-8027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant