Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 1-099073 | AL |
NPI | 1023285228 |
---|---|
Provider Name | Mr. John Wesley Hayes JR. |
First Address | Mobile, AL 36693-3316 |
Second Address | Mobile, AL 36617-2319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2008 |
Last Update Date | 15/05/2008 |