Provider Demographics
NPI:1568439602
Name:HAYNES, CATHERINE (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12261 HIGHWAY 49
Mailing Address - Street 2:STE 11
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-2976
Mailing Address - Country:US
Mailing Address - Phone:228-374-2494
Mailing Address - Fax:228-374-2713
Practice Address - Street 1:23453 CENTRAL DRIVE
Practice Address - Street 2:
Practice Address - City:SAUCIER
Practice Address - State:MS
Practice Address - Zip Code:39574-7521
Practice Address - Country:US
Practice Address - Phone:228-832-7223
Practice Address - Fax:228-374-0856
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAR789598363LF0000X
MSR789598363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00125384Medicaid
MSS20077Medicare UPIN
MS500001007Medicare PIN