Provider Demographics
NPI:1992092134
Name:HAYES, TIA AUSTIN (FNP-C)
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:AUSTIN
Last Name:HAYES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TIA
Other - Middle Name:A
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2500 N. STATE STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4609
Mailing Address - Country:US
Mailing Address - Phone:601-815-6496
Mailing Address - Fax:
Practice Address - Street 1:2500 N. STATE STREET
Practice Address - Street 2:DIVISION OF NEPHROLOGY
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4609
Practice Address - Country:US
Practice Address - Phone:601-984-5687
Practice Address - Fax:601-984-5765
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR867941363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07127782Medicaid
AL140773Medicaid
MSP01750171OtherRAILROAD MEDICARE
MSP01750171OtherRAILROAD MEDICARE
MS30250I2102Medicare PIN