Provider Demographics
NPI:1609017193
Name:HAYNES, PAULA B (APRN)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:B
Last Name:HAYNES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 HIGHWAY 72 W
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-1816
Mailing Address - Country:US
Mailing Address - Phone:864-943-0549
Mailing Address - Fax:864-227-2067
Practice Address - Street 1:1228 HIGHWAY 72 W
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-1816
Practice Address - Country:US
Practice Address - Phone:864-943-0549
Practice Address - Fax:864-227-2067
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3795363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2942Medicaid
SCAA5972Medicare PIN