Provider Demographics
NPI:1144611096
Name:HALEY, KNAWONNA (RDH)
Entity Type:Individual
Prefix:MRS
First Name:KNAWONNA
Middle Name:
Last Name:HALEY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16407 TRACY CT
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77306-5990
Mailing Address - Country:US
Mailing Address - Phone:979-864-9102
Mailing Address - Fax:
Practice Address - Street 1:27631 DECKER PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:TX
Practice Address - Zip Code:77362-4157
Practice Address - Country:US
Practice Address - Phone:281-356-3351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17990124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124Q0000XOtherINSURANCE