Provider Demographics
NPI:1164295408
Name:PUCKETT, HAILEY
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 WHITESIDE HILL RD
Mailing Address - Street 2:
Mailing Address - City:WARTRACE
Mailing Address - State:TN
Mailing Address - Zip Code:37183-3030
Mailing Address - Country:US
Mailing Address - Phone:931-224-6485
Mailing Address - Fax:
Practice Address - Street 1:155 HOSPITAL RD STE C
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2495
Practice Address - Country:US
Practice Address - Phone:931-967-8258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34800363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health