Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 1013543974 | LA |
NPI | 1013543974 |
---|---|
Provider Name | Kevin Patrick Haynes JR. |
First Address | Baton Rouge, LA 70809-2115 |
Second Address | Baton Rouge, LA 70809-2115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2020 |
Last Update Date | 24/10/2021 |