MEDICARE: MARY KATHERINE HAYES MSN, BSN, RN, CPNPPC

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	363LP0200X	Pediatric Nurse Practitioner	11031793	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	P95VZ	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1760241418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY KATHERINE HAYES MSN, BSN, RN, CPNPPC

Provider Business Mailing Address
First Line	:	757 E US HIGHWAY 80 STE 240
Second Line	:
City	:	FORNEY
State	:	TX
Zip	:	75126-8701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	757 E US HIGHWAY 80 STE 240
Second Line	:
City	:	FORNEY
State	:	TX
Zip	:	75126-8701
Country	:	US
Telephone Number	:	469-290-4592
Fax Number	:	469-290-4593

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

Provider Enumeration Date	:	03/15/2024
Last Update Date	:	09/22/2025

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