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 1:155 HOSPITAL RD SUITE C
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:931-962-3297
Mailing Address - Fax:
Practice Address - Street 1:16110 MCARTHUR ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37388
Practice Address - Country:US
Practice Address - Phone:931-962-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34800363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health