Basic Information
Provider Information
NPI: 1407421688
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAYES
FirstName: RACHEL
MiddleName: ELAINE
NamePrefix:  
NameSuffix:  
Credential: PA
OtherOrganizationName:  
OtherOrganizationType:  
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OtherFirstName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 900 SOUTH LIMESTONE STREET
Address2:  
City: LEXINGTON
State: KY
PostalCode: 405360001
CountryCode: US
TelephoneNumber: 8593231100
FaxNumber:  
Practice Location
Address1: 2195 HARRODSBURG RD
Address2:  
City: LEXINGTON
State: KY
PostalCode: 405043516
CountryCode: US
TelephoneNumber: 8593232232
FaxNumber: 8592571078
Other Information
ProviderEnumerationDate: 05/20/2021
LastUpdateDate: 05/11/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/11/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700XPA2860KYN Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
363AS0400XPA2860KYN Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
363A00000XPA2860KYY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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