Provider Demographics
NPI:1811551179
Name:HAYES, RANDALL L SR (RN)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:L
Last Name:HAYES
Suffix:SR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9025 COUNTY ROAD 6875
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-6025
Mailing Address - Country:US
Mailing Address - Phone:806-500-1754
Mailing Address - Fax:
Practice Address - Street 1:1303 82ND ST STE 150
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2766
Practice Address - Country:US
Practice Address - Phone:806-687-3124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX647582163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health