Provider Demographics
NPI:1003084567
Name:TYLER HAYES, KELLI CHARI (FNP)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:CHARI
Last Name:TYLER HAYES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:C
Other - Last Name:TYLER HAYES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:7008 INDIANA AVE
Mailing Address - Street 2:STE A
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-6114
Mailing Address - Country:US
Mailing Address - Phone:806-698-8088
Mailing Address - Fax:806-698-8588
Practice Address - Street 1:7008 INDIANA AVE
Practice Address - Street 2:STE A
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-6114
Practice Address - Country:US
Practice Address - Phone:806-698-8088
Practice Address - Fax:806-698-8588
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX688780363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194657602Medicaid
TX00395NOtherBC BSTX
TX194657602Medicaid