Provider Demographics
NPI:1699433995
Name:HAYNIE, CARLA MAY
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:MAY
Last Name:HAYNIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:KENOVA
Mailing Address - State:WV
Mailing Address - Zip Code:25530-1417
Mailing Address - Country:US
Mailing Address - Phone:304-208-5652
Mailing Address - Fax:
Practice Address - Street 1:1014 BEECH ST
Practice Address - Street 2:
Practice Address - City:KENOVA
Practice Address - State:WV
Practice Address - Zip Code:25530-1417
Practice Address - Country:US
Practice Address - Phone:304-208-5652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant