Provider Demographics
NPI:1114790532
Name:HALEY, JACKI (BSN)
Entity Type:Individual
Prefix:
First Name:JACKI
Middle Name:
Last Name:HALEY
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:JACKI
Other - Middle Name:
Other - Last Name:CONNERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN
Mailing Address - Street 1:516 W 11TH ST STE 108B
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-7310
Mailing Address - Country:US
Mailing Address - Phone:308-233-3100
Mailing Address - Fax:308-455-4182
Practice Address - Street 1:516 W 11TH ST STE 108B
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-7310
Practice Address - Country:US
Practice Address - Phone:308-233-3100
Practice Address - Fax:308-455-4182
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE65766163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse