Healthcare Provider Details

I. General information

NPI: 1568043024
Provider Name (Legal Business Name): CAITLIN HAYNES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 PLEASANT HILL GLIMP RD
HENNING TN
38041-6448
US

IV. Provider business mailing address

261 PLEASANT HILL GLIMP RD
HENNING TN
38041-6448
US

V. Phone/Fax

Practice location:
  • Phone: 731-413-9660
  • Fax:
Mailing address:
  • Phone: 731-413-9660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number29806
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number223961
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: