Provider Demographics
NPI:1437740842
Name:HAYES, LUSHELL (FNP)
Entity Type:Individual
Prefix:MS
First Name:LUSHELL
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 N ROAD ST STE 9
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3467
Mailing Address - Country:US
Mailing Address - Phone:252-331-1100
Mailing Address - Fax:
Practice Address - Street 1:1134 N ROAD ST STE 9
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3467
Practice Address - Country:US
Practice Address - Phone:252-339-4978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAYE-2YV3Q363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHAYE-2YV3QOtherOTHER INSURANCE
NCHAYE-2YV3QMedicaid