Provider Demographics
NPI:1982230959
Name:HAYES, CASSANDRA TREADWELL (APRN)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:TREADWELL
Last Name:HAYES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 WOODLAND WAY
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29696-2731
Mailing Address - Country:US
Mailing Address - Phone:386-479-7955
Mailing Address - Fax:
Practice Address - Street 1:865 OLD CLEMSON HWY
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-8060
Practice Address - Country:US
Practice Address - Phone:864-520-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-21
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC209579163W00000X
SC23832363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily