Provider Demographics
NPI:1760613343
Name:HAYS, LISA R (PA-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:HAYS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 W. 35TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2886
Mailing Address - Country:US
Mailing Address - Phone:308-865-2570
Mailing Address - Fax:308-865-2508
Practice Address - Street 1:2810 W. 35TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2886
Practice Address - Country:US
Practice Address - Phone:308-865-2570
Practice Address - Fax:308-865-2508
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1460363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
099168002(PTAN)Medicare PIN