MEDICARE: DYSYAN HAYNIE PMHNP

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	2024039932	MO

General Provider Information

NPI Number	:	1275351009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DYSYAN HAYNIE PMHNP

Provider Business Mailing Address
First Line	:	5206 PRIMAVERA LN
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76549-5446
Country	:	US
Telephone Number	:	719-460-4571
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 E COUNTY DR
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65202-9064
Country	:	US
Telephone Number	:	573-875-1111
Fax Number	:

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

Provider Enumeration Date	:	10/01/2024
Last Update Date	:	02/25/2026

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