Provider Demographics
NPI:1265637292
Name:HALEY, SHIRLEY CATHERINE (CFNP)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:CATHERINE
Last Name:HALEY
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 N 2ND ST
Mailing Address - Street 2:STE 205
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591
Mailing Address - Country:US
Mailing Address - Phone:812-895-8000
Mailing Address - Fax:812-895-8006
Practice Address - Street 1:328 N 2ND ST
Practice Address - Street 2:STE 205
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591
Practice Address - Country:US
Practice Address - Phone:812-895-8000
Practice Address - Fax:812-895-8006
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000028A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200442400Medicaid
IN441910SMedicare PIN
P02260Medicare UPIN
IN4419105Medicare ID - Type Unspecified