Provider Demographics
NPI:1568710283
Name:HAYNE, JAMIE ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:ELIZABETH
Last Name:HAYNE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3327 CORAL GROVE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-4821
Mailing Address - Country:US
Mailing Address - Phone:210-823-4336
Mailing Address - Fax:
Practice Address - Street 1:109 GALLERY CIR
Practice Address - Street 2:STE 131
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3327
Practice Address - Country:US
Practice Address - Phone:210-490-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXPA08066363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX306945201Medicaid
TX306945201Medicaid