Provider Demographics
NPI:1154642577
Name:HAYES, KATHRYN KORRELL (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:KORRELL
Last Name:HAYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 E BRIAR ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7511
Mailing Address - Country:US
Mailing Address - Phone:314-607-0262
Mailing Address - Fax:
Practice Address - Street 1:2016 E BRIAR ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7511
Practice Address - Country:US
Practice Address - Phone:314-607-0262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010017229207Q00000X
MO2013013916207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1154642577Medicaid
MO132680730Medicare PIN
MO132300603Medicare PIN