Provider Demographics
NPI:1710280409
Name:HAYNES, RACHEL IRENE (CPNP, DNP)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:IRENE
Last Name:HAYNES
Suffix:
Gender:F
Credentials:CPNP, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7310
Mailing Address - Country:US
Mailing Address - Phone:805-361-8030
Mailing Address - Fax:805-361-8097
Practice Address - Street 1:430 S BLOSSER RD
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-4908
Practice Address - Country:US
Practice Address - Phone:805-361-8900
Practice Address - Fax:805-361-8990
Is Sole Proprietor?:No
Enumeration Date:2010-12-18
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO109947363LP0200X
CA14788363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66981816Medicaid