MEDICARE: MARY C HAYNES

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	363LF0000X	Family Nurse Practitioner	907473	MS

General Provider Information

NPI Number	:	1922987478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY C HAYNES

Provider Business Mailing Address
First Line	:	690 N SPRING AVE
Second Line	:
City	:	LOUISVILLE
State	:	MS
Zip	:	39339-2215
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2526 5TH ST N STE B
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39705-2019
Country	:	US
Telephone Number	:	662-269-0592
Fax Number	:

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

Provider Enumeration Date	:	08/28/2025
Last Update Date	:	10/27/2025

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Directions to “ MARY C HAYNES ” Practice Location

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