Provider Demographics
NPI:1891384962
Name:HAYES, JANE MARIE
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:MARIE
Last Name:HAYES
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 1:920 N MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75979-4519
Mailing Address - Country:US
Mailing Address - Phone:409-283-5556
Mailing Address - Fax:409-283-5557
Practice Address - Street 1:1273 S PEACHTREE ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-4915
Practice Address - Country:US
Practice Address - Phone:409-384-9200
Practice Address - Fax:409-384-9205
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1004880363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily