Provider Demographics
NPI:1992050983
Name:HAYNES, LISA MICHELLE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MICHELLE
Last Name:HAYNES
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 FRANKLIN FARMS DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-5108
Mailing Address - Country:US
Mailing Address - Phone:804-521-5800
Mailing Address - Fax:
Practice Address - Street 1:4700 PUDDLEDOCK RD
Practice Address - Street 2:SUITE 400
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-1237
Practice Address - Country:US
Practice Address - Phone:804-458-1740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170184363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily