Provider Demographics
NPI:1164136222
Name:LAWSON, HALEY ISHAM (PA-C)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:ISHAM
Last Name:LAWSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 ALDEN DR BLDG 160
Mailing Address - Street 2:
Mailing Address - City:FE WARREN AFB
Mailing Address - State:WY
Mailing Address - Zip Code:82005-3913
Mailing Address - Country:US
Mailing Address - Phone:920-573-2944
Mailing Address - Fax:
Practice Address - Street 1:6900 ALDEN DR BLDG 160
Practice Address - Street 2:
Practice Address - City:FE WARREN AFB
Practice Address - State:WY
Practice Address - Zip Code:82005-3913
Practice Address - Country:US
Practice Address - Phone:920-573-2944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171000000XOther Service ProvidersMilitary Health Care Provider