Provider Demographics
NPI:1295207124
Name:HAYS, FAWN ARDELL
Entity Type:Individual
Prefix:
First Name:FAWN
Middle Name:ARDELL
Last Name:HAYS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 N STOCKMAN RD
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-4028
Mailing Address - Country:US
Mailing Address - Phone:918-695-6013
Mailing Address - Fax:
Practice Address - Street 1:1024 N STOCKMAN RD
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-4028
Practice Address - Country:US
Practice Address - Phone:918-695-6013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator