Basic Information
| Provider Information | |||||||||
| NPI: | 1003084567 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TYLER HAYES | ||||||||
| FirstName: | KELLI | ||||||||
| MiddleName: | CHARI | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TYLER HAYES | ||||||||
| OtherFirstName: | KELLI | ||||||||
| OtherMiddleName: | C | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | NP-C | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7008 INDIANA AVE | ||||||||
| Address2: | STE A | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794136114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8066988088 | ||||||||
| FaxNumber: | 8066988588 | ||||||||
| Practice Location | |||||||||
| Address1: | 7008 INDIANA AVE | ||||||||
| Address2: | STE A | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794136114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8066988088 | ||||||||
| FaxNumber: | 8066988588 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2008 | ||||||||
| LastUpdateDate: | 04/08/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 688780 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 194657602 | 05 | TX | MEDICAID | 00395N | 01 | TX | BC BSTX | OTHER |