Provider Demographics
NPI:1083169171
Name:DEBUSK, HALEY HENARD (PA)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:HENARD
Last Name:DEBUSK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 N. BROAD STREET
Mailing Address - Street 2:NEW TAZWELL
Mailing Address - City:TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37825
Mailing Address - Country:US
Mailing Address - Phone:423-257-5700
Mailing Address - Fax:865-374-2200
Practice Address - Street 1:424 N. BROAD STREET
Practice Address - Street 2:NEW TAZWELL
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37825
Practice Address - Country:US
Practice Address - Phone:423-257-5700
Practice Address - Fax:865-374-2200
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ024690Medicaid