Provider Demographics
NPI:1801998414
Name:HAYNES, DONNA J
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:J
Last Name:HAYNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 S HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:75117-3113
Mailing Address - Country:US
Mailing Address - Phone:903-896-3333
Mailing Address - Fax:903-896-3334
Practice Address - Street 1:616 W RUSSELL PL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3658
Practice Address - Country:US
Practice Address - Phone:800-257-8715
Practice Address - Fax:800-819-1655
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX538593364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX890001104OtherRAIL ROAD
TX8N2957OtherBLUE CROSS BLUE SHIELD
TX152560203Medicaid
TX8N3132OtherBLUE CROSS BLUE SHIELD
TX152560202Medicaid
TX8A6163Medicare ID - Type UnspecifiedDALLAS
TX87882HMedicare ID - Type Unspecified