Provider Demographics
NPI:1245677178
Name:HAYES, JESSICA RYAN (BA)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:RYAN
Last Name:HAYES
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 KENYON RD
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:VA
Mailing Address - Zip Code:24179-1203
Mailing Address - Country:US
Mailing Address - Phone:540-915-4835
Mailing Address - Fax:757-216-0131
Practice Address - Street 1:709 KENYON RD
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:VA
Practice Address - Zip Code:24179-1203
Practice Address - Country:US
Practice Address - Phone:540-915-4835
Practice Address - Fax:757-216-0131
Is Sole Proprietor?:No
Enumeration Date:2013-06-01
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator