Provider Demographics
NPI:1003276312
Name:HILL, HALEY PATRICK
Entity Type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:PATRICK
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:
Other - Last Name:PATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11949 GLEN RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNDVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35474-6356
Mailing Address - Country:US
Mailing Address - Phone:205-799-7979
Mailing Address - Fax:
Practice Address - Street 1:100 RICE MINE ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406
Practice Address - Country:US
Practice Address - Phone:205-349-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-35504363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5381OtherCRNP RX NUMBER