Provider Demographics
NPI:1275538613
Name:HAYNES, TINA S (MD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:S
Last Name:HAYNES
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 1:6931 W GARDEN RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205
Mailing Address - Country:US
Mailing Address - Phone:316-773-2461
Mailing Address - Fax:
Practice Address - Street 1:6837 W 37TH STREET NORTH
Practice Address - Street 2:BLDG 1
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205
Practice Address - Country:US
Practice Address - Phone:316-773-3100
Practice Address - Fax:316-773-3777
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-30261208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS04-30261OtherKANSAS LICENSE NUMBER
KS04-30261OtherKANSAS LICENSE NUMBER