Provider Demographics
NPI:1447449053
Name:HAYES, HEATHER LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:HAYES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 S STEPHENSON AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-3650
Mailing Address - Country:US
Mailing Address - Phone:906-774-1633
Mailing Address - Fax:906-774-1633
Practice Address - Street 1:1711 S STEPHENSON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3650
Practice Address - Country:US
Practice Address - Phone:906-774-1633
Practice Address - Fax:906-077-4163
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005078363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIHH005078OtherBCBS OF MI
MIHH005078OtherBCBS OF MI
233872Medicare PIN