Provider Demographics
NPI:1164171070
Name:HAM, HALEY KENIMER (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:KENIMER
Last Name:HAM
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:MISS
Other - First Name:HALEY
Other - Middle Name:ELIZABETH
Other - Last Name:KENIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4000 FABER PLACE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-8587
Mailing Address - Country:US
Mailing Address - Phone:737-226-6700
Mailing Address - Fax:877-384-3106
Practice Address - Street 1:722 S DARGAN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2562
Practice Address - Country:US
Practice Address - Phone:843-669-4403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-20
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily