Provider Demographics
NPI:1891004735
Name:HAYWARD, KELLY C (LPN)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:C
Last Name:HAYWARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 FERNVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-4471
Mailing Address - Country:US
Mailing Address - Phone:978-500-1534
Mailing Address - Fax:
Practice Address - Street 1:69 FERNVIEW AVE
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-4471
Practice Address - Country:US
Practice Address - Phone:978-500-1534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN87166164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse