Provider Demographics
NPI:1104383231
Name:HAYES, JADE LAURYN-ASHLEE (BS)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:LAURYN-ASHLEE
Last Name:HAYES
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-8039
Mailing Address - Country:US
Mailing Address - Phone:361-652-4670
Mailing Address - Fax:
Practice Address - Street 1:111 E 12TH ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-6501
Practice Address - Country:US
Practice Address - Phone:580-436-2690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX972228945OtherUNITED HEALTHCARE