Provider Demographics
NPI:1942579347
Name:ANGELA HEBERT HAYDEN NP
Entity Type:Organization
Organization Name:ANGELA HEBERT HAYDEN NP
Other - Org Name:FOOTHILLS NURSE PRACTITIONER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:HEBERT
Authorized Official - Last Name:HAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:704-640-8101
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:CENTRAL
Mailing Address - State:SC
Mailing Address - Zip Code:29630-0909
Mailing Address - Country:US
Mailing Address - Phone:704-640-8101
Mailing Address - Fax:
Practice Address - Street 1:400-4 COLLEGE AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-2925
Practice Address - Country:US
Practice Address - Phone:864-986-2370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3859364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA46280281Medicare UPIN
SC0281Medicare PIN