Provider Demographics
NPI:1164464384
Name:HANES, THERESA A (CRNP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:HANES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SAINT CLAIR AVE SW
Mailing Address - Street 2:BLDG 6 SUITE 14
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 SAINT CLAIR AVE SW
Practice Address - Street 2:BLDG 6 SUITE 14
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5008
Practice Address - Country:US
Practice Address - Phone:256-536-4700
Practice Address - Fax:256-536-4117
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1049736363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-45706OtherBCBS OF ALABAMA
AL051528320OtherBLUE CROSS BLUE SHIELD AL
AL510-50070OtherBCBS OF ALABAMA
ALP00214863OtherRR MEDICARE
ALCA0084OtherRR MEDICARE
AL515-94366OtherBCBS OF ALABAMA
AL51111375OtherBCBS OF ALABAMA
AL515-45707OtherBCBS OF ALABAMA
AL515-45708OtherBCBS OF ALABAMA
AL515-45764OtherBCBS OF ALABAMA
AL528701110Medicaid
ALCA0084OtherRR MEDICARE
ALP00214863OtherRR MEDICARE
AL515-94366OtherBCBS OF ALABAMA
AL515-45708OtherBCBS OF ALABAMA