Provider Demographics
NPI:1851946545
Name:HAYS, JESSE A (APRN)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:A
Last Name:HAYS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1560
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-3560
Mailing Address - Country:US
Mailing Address - Phone:270-725-9700
Mailing Address - Fax:270-783-3751
Practice Address - Street 1:1405 NASHVILLE ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-8857
Practice Address - Country:US
Practice Address - Phone:270-725-9700
Practice Address - Fax:270-783-3751
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3013733363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100614190Medicaid