Healthcare Provider Details

I. General information

NPI: 1760387005
Provider Name (Legal Business Name): MACEY CELESTE MARTIN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 W MAIN ST STE 1401
LEBANON TN
37087-6097
US

IV. Provider business mailing address

1405 IDLEWILD DR
LEBANON TN
37087-3232
US

V. Phone/Fax

Practice location:
  • Phone: 931-288-4619
  • Fax: 931-208-4063
Mailing address:
  • Phone: 615-552-8626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2026094757
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: