Annie Mae Haynes

Primary specialty

Nurse's AideTaxonomy code 376K00000X

License

108121 Issued in MO

Practice address

2610 Saint Louis Ave
East Saint Louis, IL 62205-1540

Phone

(314) 495-1611

NPI assigned

Feb 15, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Annie Mae Cooper Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1707955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707955200000",
    "number": "1518722982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2610 SAINT LOUIS AVE",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622051540",
            "telephone_number": "314-495-1611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2610 SAINT LOUIS AVE",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622051540",
            "telephone_number": "314-495-1611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAYNES",
        "first_name": "ANNIE",
        "middle_name": "MAE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-02-15",
        "last_updated": "2024-02-15",
        "certification_date": "2024-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "376K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse's Aide",
            "state": "MO",
            "license": "108121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANNIE",
            "last_name": "COOPER",
            "middle_name": "MAE",
            "credential": "JACKSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Dolores J Gunn, M.D.
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• Robert Dean Harper, RPH
• Erica Harvey
• Mohammad Hashemi, MD
• Valda Haywood, LCSW
• Hazel Bland Promise Center
• Carrie Linda Hegdahl, NCSP
• Alissa Anne Helm, DO
• Harry George Henderson, DDS

• Nurse's Aide in East Saint Louis, IL
• Providers in East Saint Louis, IL by specialty
• Nurse's Aide in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.