Provider Demographics
NPI:1144771700
Name:HAYNES, REBECCA KAYE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:KAYE
Last Name:HAYNES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:KAYE
Other - Last Name:MARSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16224 FISHMARKET RD
Mailing Address - Street 2:
Mailing Address - City:MCLOUD
Mailing Address - State:OK
Mailing Address - Zip Code:74851-9345
Mailing Address - Country:US
Mailing Address - Phone:405-201-1389
Mailing Address - Fax:
Practice Address - Street 1:104 E SHURDEN INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:HENRYETTA
Practice Address - State:OK
Practice Address - Zip Code:74437-7323
Practice Address - Country:US
Practice Address - Phone:918-652-9614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2019-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0058354363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily