Provider Demographics
NPI:1477705325
Name:DEVRIES, HAYLEE BROOK (PA-C)
Entity type:Individual
Prefix:
First Name:HAYLEE
Middle Name:BROOK
Last Name:DEVRIES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6780 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2203
Mailing Address - Country:US
Mailing Address - Phone:440-312-5569
Mailing Address - Fax:440-312-5562
Practice Address - Street 1:6780 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2203
Practice Address - Country:US
Practice Address - Phone:440-312-5569
Practice Address - Fax:440-312-5562
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2024-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.007896RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX431737ZQJWMedicare PIN
TXTXB144798Medicare PIN
NM18187731Medicaid
TX198793503Medicaid