Individual provider Active NPI

Stephanie J Hayes, ARNP

  • Nurse Practitioner
  • Walla Walla, WA
National Provider Identifier
1861034605
Registry record updated Apr 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP61034032 Issued in WA
Practice address
1111 S 2ND Ave
Walla Walla, WA 99362-4118
Phone
(509) 897-3700
Fax
(509) 897-5575
NPI assigned
Oct 14, 2019
Last updated
Apr 26, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP61034032 WA Primary
Family Nurse Practitioner 363LF0000X AP61034032 WA
Registered Nurse 163W00000X RN00171949 WA

Addresses

Primary practice location

1111 S 2ND Ave
Walla Walla, WA 99362-4118

Mailing address

PO Box 32
Liberty Lake, WA 99019-0032
Phone (866) 747-2455

Other practice location 1

1225 SE Commercial Dr
College Place, WA 99324-9721
Phone (509) 516-1101

Other identifiers 1

IdentifierTypeStateIssuer
2147926MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200214000538 WA Practitioner - Nurse Practitioner 3971939711 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN00171949WAMDRegistered Nurse
AP61034032WAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Physicians Immediate Care & Medical Centers, P.S. CurrentSince Sep 12, 2022 Accepting new patients

Locations

1225 SE Commercial Dr
College Place, WA 99324
Phone (509) 516-1101

1516 Jadwin Ave
Richland, WA 99354
Phone (509) 946-1695

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1571011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682467200000",
    "number": "1861034605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 32",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990190032",
            "telephone_number": "866-747-2455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 S 2ND AVE",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993624118",
            "telephone_number": "509-897-3700",
            "fax_number": "509-897-5575"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1225 SE Commercial Dr",
            "address_purpose": "LOCATION",
            "city": "College Place",
            "state": "WA",
            "postal_code": "993249721",
            "country_code": "US",
            "telephone_number": "509-516-1101",
            "fax_number": "509-516-1102",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAYES",
        "first_name": "STEPHANIE",
        "middle_name": "J",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-14",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP61034032",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP61034032",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN00171949",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2147926",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Walla Walla, WA

Sources for this page

Verify at the official NPI Registry.