Provider Demographics
NPI:1144631649
Name:HAYSLETT, ANDREW RICHARD
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:RICHARD
Last Name:HAYSLETT
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 1:2500 N. STATE ST.
Mailing Address - Street 2:CBO - SUITE 4200
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-496-9794
Mailing Address - Fax:601-815-0434
Practice Address - Street 1:2500 N. STATE ST.
Practice Address - Street 2:UMMC, DEPARTMENT OF PEDIATRICS
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:601-815-6211
Practice Address - Fax:601-815-8250
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS25144208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics