Provider Demographics
NPI:1538137906
Name:HAYES, TIFFANY R (PA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:R
Last Name:HAYES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:NICOLE
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:500 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4442
Mailing Address - Country:US
Mailing Address - Phone:337-239-8000
Mailing Address - Fax:337-239-8003
Practice Address - Street 1:500 S 6TH ST
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4442
Practice Address - Country:US
Practice Address - Phone:337-239-8000
Practice Address - Fax:337-239-8003
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LATPA149363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical