Provider Demographics
NPI:1376996710
Name:HAYNES, ANGELA D (FNP-C)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:D
Last Name:HAYNES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4301 W MARKHAM ST # 783
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-686-8000
Mailing Address - Fax:501-526-5148
Practice Address - Street 1:1617 N WASHINGTON
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-2046
Practice Address - Country:US
Practice Address - Phone:870-234-7676
Practice Address - Fax:570-562-2559
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAAP08913363LF0000X
AR228116363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2428551Medicaid