Provider Demographics
NPI:1598491904
Name:HAYNES, IESHA CHERELLE
Entity Type:Individual
Prefix:MISS
First Name:IESHA
Middle Name:CHERELLE
Last Name:HAYNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 TELEPHONE RD STE B
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39567-3350
Mailing Address - Country:US
Mailing Address - Phone:228-249-2952
Mailing Address - Fax:
Practice Address - Street 1:2010 TELEPHONE RD STE B
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39567-3350
Practice Address - Country:US
Practice Address - Phone:228-249-2952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion