Provider Demographics
NPI:1609858109
Name:HAYHURST, BETTY G (MSN, APRN, BC (FNP))
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:G
Last Name:HAYHURST
Suffix:
Gender:F
Credentials:MSN, APRN, BC (FNP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8023
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-8023
Mailing Address - Country:US
Mailing Address - Phone:662-286-5055
Mailing Address - Fax:662-286-9700
Practice Address - Street 1:820 HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-7954
Practice Address - Country:US
Practice Address - Phone:662-286-5055
Practice Address - Fax:662-286-9700
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR560634363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05637763Medicaid
MS500001489Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
MS05637763Medicaid