Provider Demographics
NPI:1033355284
Name:HAYNIE, KEITH BRYAN (DNP, RN, CFNP)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:BRYAN
Last Name:HAYNIE
Suffix:
Gender:M
Credentials:DNP, RN, CFNP
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-8095
Mailing Address - Country:US
Mailing Address - Phone:860-788-6404
Mailing Address - Fax:860-398-6441
Practice Address - Street 1:206 S CORONADO AVE
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2792
Practice Address - Country:US
Practice Address - Phone:860-788-6404
Practice Address - Fax:860-398-6441
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMR45728363LF0000X
NMCNP01098363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily