Provider Demographics
NPI:1134367618
Name:SHARON R. HAYNES
Entity type:Organization
Organization Name:SHARON R. HAYNES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:RENA
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-586-8430
Mailing Address - Street 1:9805 WALNUT ST.
Mailing Address - Street 2:C-106
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-2844
Mailing Address - Country:US
Mailing Address - Phone:214-586-8430
Mailing Address - Fax:
Practice Address - Street 1:9805 WALNUT ST.
Practice Address - Street 2:C-106
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-2844
Practice Address - Country:US
Practice Address - Phone:214-586-8430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX640659374T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing PersonnelGroup - Multi-Specialty