Individual
JENNIFER B HAYNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
F.N.P
Contact information
Practice address
3236 HOLMESTOWN RD, SUITE E1, MYRTLE BEACH, SC 29588-7495
(843) 663-8000
Mailing address
PO BOX 547, LITTLE RIVER, SC 29566-0547
(843) 663-8000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4031
SC
363LF0000X
Family Nurse Practitioner
RN122940
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4031
SC STATE LICENSE
SC
05
—
7004853
—
NC
05
—
NP0413
—
SC
01
—
RN122940
STATE LICENSE
GA
Enumeration date
04/23/2008
Last updated
04/01/2016
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