MEDICARE: HAYLEY MARIE REYNOLDS DIXIE PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	28279019A	IN

General Provider Information

NPI Number	:	1073463832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAYLEY MARIE REYNOLDS DIXIE PMHNP-BC

Provider Business Mailing Address
First Line	:	2710 LAKE AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-5412
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2710 LAKE AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-5412
Country	:	US
Telephone Number	:	260-280-0128
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2026
Last Update Date	:	03/11/2026

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