Provider Demographics
NPI:1679233944
Name:HAINES, CODY HAMPTON (APRN-NP-C)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:HAMPTON
Last Name:HAINES
Suffix:
Gender:M
Credentials:APRN-NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:908 ROCKMOOR DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-8966
Mailing Address - Country:US
Mailing Address - Phone:512-868-0901
Mailing Address - Fax:512-868-1527
Practice Address - Street 1:908 ROCKMOOR DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-8966
Practice Address - Country:US
Practice Address - Phone:512-868-0901
Practice Address - Fax:512-868-1527
Is Sole Proprietor?:No
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1057768363LP2300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care