Provider Demographics
NPI:1346749926
Name:EDMONSTON, HAYLEY (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:
Last Name:EDMONSTON
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 1:2994 WOODHAVEN CIR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-1241
Mailing Address - Country:US
Mailing Address - Phone:478-283-8015
Mailing Address - Fax:
Practice Address - Street 1:2994 WOODHAVEN CIR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-1241
Practice Address - Country:US
Practice Address - Phone:478-508-1959
Practice Address - Fax:478-508-1959
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2017035164363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health