Individual provider · NPI-1

Dr. Keith Bryan Haynie, DNP, RN, CFNP

Nurse Practitioner, Psych/Mental Health · Espanola, NM

NPI number1033355284
StatusActive
Last updated in NPPESApr 30, 2024

Details

NPI
1033355284
Entity type
Individual (NPI-1)
Name
Dr. Keith Bryan Haynie
Credential
DNP, RN, CFNP
Sex
Male
Sole proprietor
No
Enumeration date
Dec 17, 2008
Certification date
Apr 30, 2024
Last updated
Apr 30, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LP0808X Nurse Practitioner, Psych/Mental HealthCNP01098NMYes
363LF0000X Nurse Practitioner, FamilyR45728NM

Practice location

206 S Coronado Ave
Espanola, NM 87532-2792

Phone 860-788-6404 · Fax 860-398-6441

Mailing address

Po Box 1595
Middletown, CT 06457-8095

Phone 860-788-6404 · Fax 860-398-6441

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