Provider Demographics
NPI:1235329764
Name:HAYNES, WANDA MARIE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:MARIE
Last Name:HAYNES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:MARIE
Other - Last Name:HAYNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:9411 N OAK TRFY STE LL1
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2262
Mailing Address - Country:US
Mailing Address - Phone:816-691-1655
Mailing Address - Fax:
Practice Address - Street 1:9411 N OAK TRFY STE 205
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-2229
Practice Address - Country:US
Practice Address - Phone:816-691-3546
Practice Address - Fax:816-346-7474
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111047363LF0000X
TX726951363LF0000X
LAAP07135363LF0000X
IAA-123907363LF0000X
MO2019040422363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47428OtherBCBS NE
NENA1466009Medicare PIN
NE099827008Medicare PIN
NEP00986870Medicare PIN