Provider Demographics
NPI:1922458538
Name:HAYS, AMBER RAE
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:RAE
Last Name:HAYS
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 1:1595 YELLOWSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4203
Mailing Address - Country:US
Mailing Address - Phone:208-233-0032
Mailing Address - Fax:208-237-9171
Practice Address - Street 1:1595 YELLOWSTONE AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4203
Practice Address - Country:US
Practice Address - Phone:208-233-0032
Practice Address - Fax:208-237-9171
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
ID363AS0400X
NY027276363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical