Provider Demographics
NPI:1033241559
Name:HAYES, KIMBERLY DAWN (MAED)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DAWN
Last Name:HAYES
Suffix:
Gender:F
Credentials:MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 W TACKETT DR
Mailing Address - Street 2:
Mailing Address - City:TEABERRY
Mailing Address - State:KY
Mailing Address - Zip Code:41660-6321
Mailing Address - Country:US
Mailing Address - Phone:606-587-2132
Mailing Address - Fax:606-587-1314
Practice Address - Street 1:74 W TACKETT DR
Practice Address - Street 2:
Practice Address - City:TEABERRY
Practice Address - State:KY
Practice Address - Zip Code:41660-6321
Practice Address - Country:US
Practice Address - Phone:606-587-2132
Practice Address - Fax:606-587-1314
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator