Jennifer Hayhurst Physician Assistant Apc

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

JENNIFER HAYHURST PHYSICIAN ASSISTANT APC

Practice address

1467 Ford St Ste 101
Redlands, CA 92373-3911

Phone

(909) 551-3376

NPI assigned

Jul 26, 2023

Organization subpart

No

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

Authorized official

Name

Jennifer Hayhurst, PA-CNPI 1649664079

Title

Owner

Phone

(949) 836-1262

Specialties & licenses 1

Addresses

Other names 1

• Radiant Dermatology Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer Darlene Hayhurst, P.A.-C.

  • Physician Assistant
  • Redlands, CA
  • NPI 1649664079
  Medicare reassignment Authorized official
• Fred F Soeprono, M.D.

  • Dermatology Physician
  • Loma Linda, CA
  • NPI 1659485746
  Medicare reassignment NPD
• Todd Coleman Rau, M.D.

  • Plastic and Reconstructive Surgery Physician
  • Redlands, CA
  • NPI 1023030319
  NPD

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

{
    "created_epoch": "1690329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697068800000",
    "number": "1699456392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 E REDLANDS BLVD STE U342",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923736109",
            "telephone_number": "909-551-3376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1467 FORD ST STE 101",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923733911",
            "telephone_number": "909-551-3376"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17 S 5th St Ste D",
            "address_purpose": "LOCATION",
            "city": "Redlands",
            "state": "CA",
            "postal_code": "923734737",
            "country_code": "US",
            "telephone_number": "909-551-3376",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JENNIFER HAYHURST PHYSICIAN ASSISTANT APC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-26",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A",
        "authorized_official_last_name": "HAYHURST",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "949-836-1262",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Radiant Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Radiant Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• James William Jeffries
• Sharen Knudsen Jeffries, M.D.
• Jeffry Wu O.D. Professional Corporation
• Monica Jenkins, MSN, FNP-C
• Jennifer Cobanov, MD Professional Corporation
• Michelle Jensen
• Dongjun Jeong, D.D.S
• Yanghoon Peter Jeong
• Mathew Jerome
• Jessica de la Rosa Licensed Clinical Social Worker, Inc.

• Dermatology Physician in Redlands, CA
• Providers in Redlands, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.