Provider Demographics
NPI:1396358651
Name:HAYES, MICKEYA PATRICE (NP)
Entity Type:Individual
Prefix:
First Name:MICKEYA
Middle Name:PATRICE
Last Name:HAYES
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 1:5713 AMBERBROOKE ARCH APT 302
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-9150
Mailing Address - Country:US
Mailing Address - Phone:504-261-2356
Mailing Address - Fax:
Practice Address - Street 1:700 OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3728
Practice Address - Country:US
Practice Address - Phone:757-977-8500
Practice Address - Fax:757-451-9694
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179989363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty