Provider Demographics
NPI:1235284431
Name:HAYNES, CHERYL (NP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ARCHER WAY
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-4665
Mailing Address - Country:US
Mailing Address - Phone:401-241-3324
Mailing Address - Fax:401-773-7878
Practice Address - Street 1:2756 POST RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-3003
Practice Address - Country:US
Practice Address - Phone:401-384-6007
Practice Address - Fax:401-773-7878
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN32050163WP0808X
RINP37125363L00000X
RINPP37125363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0000029629OtherRI BLUE CROSS PROVIDER #
RI412667OtherRI BLUE CHIP PROVIDER #
RI007057780Medicare ID - Type Unspecified
RI412667OtherRI BLUE CHIP PROVIDER #