Individual provider Active NPI

Promise E Haynes, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Tarrytown, NY
National Provider Identifier
1912328378
Registry record updated Nov 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
404027 Issued in NY
Practice address
580 White Plains Rd Ste 510
Tarrytown, NY 10591-5152
Phone
(914) 345-0700
NPI assigned
Jan 2, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 1623528 CO
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 3014600 KY
Psychiatric/Mental Health Nurse Practitioner 363LP0808X APN.0994762-NP CO
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 4704411381 MI
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 404027 NY Primary

Addresses

Primary practice location

580 White Plains Rd Ste 510
Tarrytown, NY 10591-5152

Mailing address

580 White Plains Rd Ste 510
Tarrytown, NY 10591-5152
Phone (914) 345-0700

Other practice location 1

650 S Highway 27 Ste 5
Somerset, KY 42501-3501
Phone (914) 265-4083

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, MI2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220609001207 NY Practitioner - Nurse Practitioner 0042548182 Reassigns benefits to 1 organization
I20240613001914 MI Practitioner - Nurse Practitioner 0042548182 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Mental Health Association of Westchester County IncGroup PAC ID 0244121366, 24 clinicians

Practice addresses (Care Compare)

360 Mamaroneck Ave
White Plains, NY 10605-1700
Phone (914) 345-5900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1623528COMDRegistered Nurse
3014600KYMDPsychiatric/Mental Health Nurse Practitioner
4704411381MIMDPsychiatric/Mental Health Nurse Practitioner
404027NYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Steven Blauner PLLC CurrentSince Jul 1, 2022 Accepting new patients
Jackson-Hillsdale Community Mental Health Board CurrentSince Apr 21, 2024 Accepting new patients
Jackson-Hillsdale Community Mental Health Board CurrentSince Apr 21, 2024 Accepting new patients
The Mental Health Association of Westchester County - Social Care Network PastSince May 19, 2024 Accepting new patients

Locations

25 Care Dr
Hillsdale, MI 49242
Phone (517) 439-2641

1200 N West Ave
Jackson, MI 49202
Phone (517) 789-1200

344 E Main St
Ste 301
Mount Kisco, NY 10549
Phone (914) 263-7240

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1388620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731024000000",
    "number": "1912328378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 WHITE PLAINS RD STE 510",
            "city": "TARRYTOWN",
            "state": "NY",
            "postal_code": "105915152",
            "telephone_number": "914-345-0700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 WHITE PLAINS RD STE 510",
            "city": "TARRYTOWN",
            "state": "NY",
            "postal_code": "105915152",
            "telephone_number": "914-345-0700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "650 S Highway 27 Ste 5",
            "address_purpose": "LOCATION",
            "city": "Somerset",
            "state": "KY",
            "postal_code": "425013501",
            "country_code": "US",
            "telephone_number": "914-265-4083",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAYNES",
        "first_name": "PROMISE",
        "middle_name": "E",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-02",
        "last_updated": "2024-11-08",
        "certification_date": "2024-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CO",
            "license": "1623528",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "KY",
            "license": "3014600",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CO",
            "license": "APN.0994762-NP",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MI",
            "license": "4704411381",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "404027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tarrytown, NY

Sources for this page

Verify at the official NPI Registry.