Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 44778 | KS |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 2013010843 | MO |
NPI | 1003812918 |
---|---|
Provider Name | Karen S. Hayes |
First Address | Osage Beach, MO 65065-1500 |
Second Address | Lake Ozark, MO 65049-8658 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2005 |
Last Update Date | 31/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100383580A | (05) | KS |
160479 | BLUE CROSS BLUE SHIELD (01) | KS |
500014824 | RAIL ROAD MEDICARE (01) | |
66720A035 | TRICARE (01) | |
P16404 | (02) | KS |