Provider Demographics
NPI:1114378494
Name:FORD, HALEY ELIZABETH
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:ELIZABETH
Last Name:FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:ELIZABETH
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 441
Mailing Address - Street 2:500 HIGHWAY 61 J N
Mailing Address - City:HAYTI
Mailing Address - State:MO
Mailing Address - Zip Code:63851-0441
Mailing Address - Country:US
Mailing Address - Phone:573-359-2600
Mailing Address - Fax:
Practice Address - Street 1:500 HIGHWAY J # 61JN
Practice Address - Street 2:
Practice Address - City:HAYTI
Practice Address - State:MO
Practice Address - Zip Code:63851-1200
Practice Address - Country:US
Practice Address - Phone:573-359-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other