Provider Demographics
NPI:1114301645
Name:HAYNES, JESSICA ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANN
Last Name:HAYNES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANN
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1432 KIMBROUGH RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2405
Mailing Address - Country:US
Mailing Address - Phone:901-767-4499
Mailing Address - Fax:901-761-0727
Practice Address - Street 1:1432 KIMBROUGH RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2405
Practice Address - Country:US
Practice Address - Phone:901-767-4499
Practice Address - Fax:901-761-0727
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3258152W00000X
MS926152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist