Provider Demographics
NPI:1447812961
Name:HAYES, CRYSTAL (APRN, CNP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 19TH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-1264
Mailing Address - Country:US
Mailing Address - Phone:304-488-0768
Mailing Address - Fax:
Practice Address - Street 1:108 WASHINGTON ST W STE 11
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-2344
Practice Address - Country:US
Practice Address - Phone:304-488-0768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-04
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1850849363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily