Provider Demographics
NPI:1003172719
Name:HAYDEN, BETH ANN (FNP)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:HAYDEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:574-237-6069
Practice Address - Street 1:707 N MICHIGAN ST
Practice Address - Street 2:STE 400
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1067
Practice Address - Country:US
Practice Address - Phone:574-647-8470
Practice Address - Fax:574-647-8475
Is Sole Proprietor?:No
Enumeration Date:2012-04-06
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003954A363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201067750Medicaid
IN000001044240OtherANTHEM
IN000001044237OtherANTHEM
IN000001044238OtherANTHEM
IN000001044241OtherANTHEM
IN565800017Medicare PIN
IN000001044238OtherANTHEM
IN000001044241OtherANTHEM
IN169380039Medicare PIN