Provider Demographics
NPI:1760063127
Name:HAYNES, KRISTI JAN
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:JAN
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 1:21094 LAWRENCE 2072
Mailing Address - Street 2:
Mailing Address - City:ASH GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65604-8298
Mailing Address - Country:US
Mailing Address - Phone:417-773-6388
Mailing Address - Fax:
Practice Address - Street 1:800 N ARTHUR ST
Practice Address - Street 2:
Practice Address - City:HUMANSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65674-8655
Practice Address - Country:US
Practice Address - Phone:417-754-2208
Practice Address - Fax:417-754-1222
Is Sole Proprietor?:No
Enumeration Date:2021-04-17
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001001805224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant