Provider Demographics
NPI:1710280409
Name:HAYNES, RACHEL IRENE (CPNP, DNP)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:IRENE
Last Name:HAYNES
Suffix:
Gender:F
Credentials:CPNP, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 MORRO RD
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4435
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7700 MORRO RD
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-4435
Practice Address - Country:US
Practice Address - Phone:805-466-6622
Practice Address - Fax:805-466-6622
Is Sole Proprietor?:No
Enumeration Date:2010-12-18
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14788363LP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66981816Medicaid