Provider Demographics
NPI:1760241418
Name:HAYES, MARY KATHERINE (MSN, BSN, RN, CPNPPC)
Entity type:Individual
Prefix:
First Name:MARY KATHERINE
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
Credentials:MSN, BSN, RN, CPNPPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 E US HIGHWAY 80 STE 240
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-8701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:757 E US HIGHWAY 80 STE 240
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-8701
Practice Address - Country:US
Practice Address - Phone:469-290-4592
Practice Address - Fax:469-290-4593
Is Sole Proprietor?:No
Enumeration Date:2024-03-15
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11031793363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL121880100Medicaid
FLP95VZOtherBLUE CROSS BLUE SHIELD