Kelly Marice Roszak, PMHNP-BC
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Burns, TN
NPI 1992635510 · NPPES record last updated Jun 29, 2026
Key facts
- NPI
- 1992635510
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 42264 (TN)
- Practice address
- 1127 Old East Side Rd
Burns, TN 37029-5662 - Phone
- (216) 235-1084
- NPI assigned
- May 23, 2026
- Sex
- Female
- Sole proprietor
- No
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1127 Old E Side Rd
Burns, TN 37029-5662
5511 Virginia Way
Suite 300
Brentwood, TN 37027-7611
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2026022833 | TN | MD | Psychiatric/Mental Health Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 42264 | TN | Yes |
| Registered Nurse | 163W00000X | 265015 | TN | |
| Nurse Practitioner | 363L00000X | 42264 | TN |
Addresses
Primary practice location
1127 Old East Side Rd
Burns, TN 37029-5662
Mailing address
1127 Old East Side Rd
Burns, TN 37029-5662
Phone (216) 235-1084
Other practice location 1
5511 Virginia Way Ste 300
Brentwood, TN 37027-7611
Phone (615) 994-1000
Other names
- Kelly Marice Haynes
Other providers in Burns, TN
- Karol Lorinc
- Jady A Moses
- New Life Lodge, Inc.
- Partnering With Seniors
- Brandon Phillips
- Stephen A Sevenich
- Simple Psychiatry LLC
- Harold Glenn Speer Jr.
- Nancy Carol Storonskyj
- Elyce Alexandra Voss
All providers in Burns, TN · Psychiatric/Mental Health Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 29, 2026. 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.