Provider Demographics
NPI:1578817706
Name:HAYNES, BRETT
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:HAYNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15435 W 134TH PL
Mailing Address - Street 2:101
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-6135
Mailing Address - Country:US
Mailing Address - Phone:913-780-0030
Mailing Address - Fax:
Practice Address - Street 1:15435 W 134TH PL
Practice Address - Street 2:101
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-6135
Practice Address - Country:US
Practice Address - Phone:913-780-0030
Practice Address - Fax:913-782-2942
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS75776363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily