Provider Demographics
NPI:1124566377
Name:HAYMER, KENYA
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:
Last Name:HAYMER
Suffix:
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 1:928 BIGGS ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38108-3227
Mailing Address - Country:US
Mailing Address - Phone:901-513-1973
Mailing Address - Fax:
Practice Address - Street 1:3210 JOSLYN CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-4835
Practice Address - Country:US
Practice Address - Phone:900-151-3197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)