Provider Demographics
NPI:1467650101
Name:HAYES-BETHEL, JENNIFER IMARA (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:IMARA
Last Name:HAYES-BETHEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:IMARA
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8 TOWN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:MO
Mailing Address - Zip Code:63334-2803
Mailing Address - Country:US
Mailing Address - Phone:573-324-2241
Mailing Address - Fax:573-324-2617
Practice Address - Street 1:8 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:MO
Practice Address - Zip Code:63334-2803
Practice Address - Country:US
Practice Address - Phone:573-324-2241
Practice Address - Fax:573-324-2617
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010003211207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1467650101Medicaid