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General NPI Number Information
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NPI Number | 1396106530
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Entity Type | Organization
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Legal Business Name | HAYNES MEDICAL CLINIC
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Dates
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Enumeration Date | 03/16/2016
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Last Update Date | 03/16/2016
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Provider Practice Location Address
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Address Line | 1009 E WOOD ST
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City | PARIS
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State | TN
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Zip | 38242-4331
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Country | US
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Telephone | 731-407-4922
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Fax | 731-407-4920
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Provider Business Mailing Address
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Address Line | 1009 E WOOD ST
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City | PARIS
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State | TN
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Zip | 38242-4331
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Country | US
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Telephone | 731-407-4922
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Fax | 731-407-4920
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | TERRIE B HAYNES WATSON
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Credential | APRN-BC, FNP
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Telephone | 731-407-4922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 12936
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License Number State | TN
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