Provider Demographics
NPI:1649664079
Name:HAYHURST, JENNIFER DARLENE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DARLENE
Last Name:HAYHURST
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25815 BARTON RD
Mailing Address - Street 2:STE 101
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3894
Mailing Address - Country:US
Mailing Address - Phone:909-796-0224
Mailing Address - Fax:
Practice Address - Street 1:124 E. OLIVE AVE.
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373
Practice Address - Country:US
Practice Address - Phone:909-798-9403
Practice Address - Fax:909-335-1641
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA52146363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant