Provider Demographics
NPI:1093416760
Name:HAYNES, SAVANAH CASEY
Entity Type:Individual
Prefix:
First Name:SAVANAH
Middle Name:CASEY
Last Name:HAYNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 CEDAR LAKE BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-7815
Mailing Address - Country:US
Mailing Address - Phone:405-493-6455
Mailing Address - Fax:
Practice Address - Street 1:701 CEDAR LAKE BLVD STE 120
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-7815
Practice Address - Country:US
Practice Address - Phone:405-493-6455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-10
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK212053363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty