Provider Demographics
NPI:1033823604
Name:BRADDOCK, HALEY CARSON
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:CARSON
Last Name:BRADDOCK
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 1:2200 SAWGRASS DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-6103
Mailing Address - Country:US
Mailing Address - Phone:252-394-5675
Mailing Address - Fax:
Practice Address - Street 1:2200 SAWGRASS DR
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-6103
Practice Address - Country:US
Practice Address - Phone:252-394-5675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program