Provider Demographics
NPI:1669720587
Name:HAYMAKER, MARILYN D (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:D
Last Name:HAYMAKER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 DEVONSHIRE TRL
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-5812
Mailing Address - Country:US
Mailing Address - Phone:615-400-3608
Mailing Address - Fax:
Practice Address - Street 1:145 DEVONSHIRE TRL
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-5812
Practice Address - Country:US
Practice Address - Phone:615-813-4672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN91619163W00000X
TNAPN0000023259363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse