Provider Demographics
NPI:1013543974
Name:HAYNES, KEVIN PATRICK JR
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:PATRICK
Last Name:HAYNES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 ESSEN LN APT 3
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2115
Mailing Address - Country:US
Mailing Address - Phone:318-372-3388
Mailing Address - Fax:
Practice Address - Street 1:4155 ESSEN LN APT 3
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2115
Practice Address - Country:US
Practice Address - Phone:318-372-3388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-22
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA1013543974208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program