Provider Demographics
NPI:1154481240
Name:HAAG, KELLEY LYNN (RN)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:LYNN
Last Name:HAAG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 MOUNTAIN VIEW
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2572
Mailing Address - Country:US
Mailing Address - Phone:928-759-7072
Mailing Address - Fax:
Practice Address - Street 1:3100 MOUNTAIN VIEW
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2572
Practice Address - Country:US
Practice Address - Phone:928-759-7072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK839392OtherAHCCCS