Provider Demographics
NPI:1841287224
Name:HAYNIE, PHILLIP K (MSN- CRNA)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:K
Last Name:HAYNIE
Suffix:
Gender:M
Credentials:MSN- CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12752 KINGSTON PIKE
Mailing Address - Street 2:STE E202
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-0948
Mailing Address - Country:US
Mailing Address - Phone:865-777-0909
Mailing Address - Fax:865-777-0910
Practice Address - Street 1:550 FORT LOUDOUN MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5673
Practice Address - Country:US
Practice Address - Phone:865-777-0909
Practice Address - Fax:865-777-0910
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN134640367500000X
TN10379367500000X
TN134640367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4022222OtherBLUE CROSS/BLUE SHIELD
KY74005836Medicaid
OK621867095003OtherBLUE CROSS/BLUE SHIELD
KY74005844Medicaid
KY000000323889OtherBCBS KY
TN4022222OtherBLUE CROSS OF TN
P00632195OtherRAILROAD MEDICARE PIN
OK200200100AMedicaid
TN3630220Medicaid
KY000000323889OtherBLUE CROSS/BLUE SHIELD
TN3630220Medicaid
OK200200100AMedicaid
KY0907302Medicare PIN
TN4022222OtherBLUE CROSS/BLUE SHIELD