Clarence D Hayes, PMHNP-BC
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Gluckstadt, MS
NPI 1194604652 · NPPES record last updated Aug 30, 2025
Key facts
- NPI
- 1194604652
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 907722 (MS)
- Practice address
- 113 First Colony Blvd
Gluckstadt, MS 39110-6073 - Phone
- (601) 807-1624
- NPI assigned
- Aug 29, 2025
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 24
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- State of Mississippi - University of Mississippi Medical Center
Practice addresses (Care Compare)
2500 N State St
Jackson, MS 39216-4500
Phone (601) 898-4404
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251230001900 | MS | Practitioner - Nurse Practitioner | 5597251454 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 907722 | MS | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of Mississippi - University of Mississippi Medical Center | Current |
Accepting new patients | |
| State of Mississippi - University of Mississippi Medical Center | Current |
Accepting new patients |
Locations
2500 N State St
Jackson, MS 39216
Phone (601) 815-4775
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 907722 | MS | Yes |
Addresses
Primary practice location
113 First Colony Blvd
Gluckstadt, MS 39110-6073
Mailing address
113 First Colony Blvd
Gluckstadt, MS 39110-6073
Phone (601) 807-1624
Other providers in Gluckstadt, MS
- C & K Senior Care LLC
- Emily Taylor Fondren
- Fortitude Chiropractic and Wellness
- Gluckstadt Pharmacy LLC
- Gluckstadt Pharmacy LLC
- Healing Hands Rehabilitation Services, LLC
- Lasheika Hogan
- Bryce Hughes
- Amanda Y Kim
- Lavender Chiropractic and Wellness
All providers in Gluckstadt, MS · Psychiatric/Mental Health Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 30, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.