MEDICARE: HALEY JOHNSON 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	2084P0802X	Addiction Psychiatry Physician	905803	MS

General Provider Information

NPI Number	:	1710674189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY JOHNSON PMHNP

Provider Business Mailing Address
First Line	:	202 ROBBINS DR
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652-3229
Country	:	US
Telephone Number	:	662-587-3766
Fax Number	:

Provider Business Practice Location Address
First Line	:	297 COUNTY ROAD 244
Second Line	:
City	:	ETTA
State	:	MS
Zip	:	38627-9523
Country	:	US
Telephone Number	:	662-281-9992
Fax Number	:

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

Provider Enumeration Date	:	04/18/2023
Last Update Date	:	04/18/2023

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