Basic Information
| Provider Information | |||||||||
| NPI: | 1841287224 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAYNIE | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSN- CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12752 KINGSTON PIKE | ||||||||
| Address2: | STE E202 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379340948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8657770909 | ||||||||
| FaxNumber: | 8657770910 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 FORT LOUDOUN MEDICAL CENTER DRIVE | ||||||||
| Address2: | |||||||||
| City: | LENOIR CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377725673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8657770909 | ||||||||
| FaxNumber: | 8657770910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2005 | ||||||||
| LastUpdateDate: | 01/11/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN134640 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 10379 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 134640 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 4022222 | 01 | TN | BLUE CROSS/BLUE SHIELD | OTHER | 74005836 | 05 | KY | MEDICAID | 621867095003 | 01 | OK | BLUE CROSS/BLUE SHIELD | OTHER | 74005844 | 05 | KY | MEDICAID | 000000323889 | 01 | KY | BCBS KY | OTHER | 4022222 | 01 | TN | BLUE CROSS OF TN | OTHER | P00632195 | 01 | RAILROAD MEDICARE PIN | OTHER | 200200100A | 05 | OK | MEDICAID | 3630220 | 05 | TN | MEDICAID | 000000323889 | 01 | KY | BLUE CROSS/BLUE SHIELD | OTHER |