Healthcare Provider Details

I. General information

NPI: 1497386098
Provider Name (Legal Business Name): MARIE E HAYCOOK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2020
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 E 22ND ST
HAYS KS
67601-2372
US

IV. Provider business mailing address

105 W 13TH ST
HAYS KS
67601-3613
US

V. Phone/Fax

Practice location:
  • Phone: 785-621-4990
  • Fax:
Mailing address:
  • Phone: 785-621-4990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5380297081
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-80297-081
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: