Provider Demographics
NPI:1508171315
Name:HAYNES, KALA RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:KALA
Middle Name:RENEE
Last Name:HAYNES
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Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:335 CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-3181
Mailing Address - Country:US
Mailing Address - Phone:386-672-4001
Mailing Address - Fax:386-672-4006
Practice Address - Street 1:335 CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-3181
Practice Address - Country:US
Practice Address - Phone:386-672-4001
Practice Address - Fax:386-672-4006
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2015-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9105573363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant