Provider Demographics
NPI:1952315897
Name:HAYNES, ALICE K (ANP-BC)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:K
Last Name:HAYNES
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:
Other - Last Name:PLATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:368 FAUNCE CORNER ROAD
Practice Address - Street 2:
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1271
Practice Address - Country:US
Practice Address - Phone:508-985-5014
Practice Address - Fax:508-985-5045
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00590363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI30334-5OtherBLUECHIP
RI7009188Medicaid
RI12/14/2006OtherNHPRI
RI007009188OtherRI MEDICARE
RI1952315897OtherNPI
RI939025129OtherRI MEDICARE GROUP NUMBER
RI500020184OtherRAILROAD MEDICARE
MA0377040Medicaid
RI400771OtherBCBSRI
RI007009188OtherRI MEDICARE