Individual
ANGELA SUE HAYES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, PA-C
Contact information
Practice address
2605 E CREEKS EDGE DR, BLOOMINGTON, IN 47401-8368
(812) 333-2663
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
050302104
IN
363A00000X
Physician Assistant
Primary
10002758A
IN
363A00000X
Physician Assistant
20206
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090540457
MEDICARE
IN
05
—
100167000
—
IN
01
—
Q00263580
RAILROAD MEDICARE
IN
Enumeration date
02/25/2009
Last updated
02/09/2023
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