Provider Demographics
NPI:1437542826
Name:HAYLES, SCOTT M (APRN)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:HAYLES
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8880 NE 82ND TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64158-1313
Mailing Address - Country:US
Mailing Address - Phone:816-437-8122
Mailing Address - Fax:816-407-9609
Practice Address - Street 1:8880 NE 82ND TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64158-1313
Practice Address - Country:US
Practice Address - Phone:816-437-8122
Practice Address - Fax:816-407-9609
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015000863363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01453159OtherRR MEDICARE
MO1437542826Medicaid
MO701000258Medicare PIN