Provider Demographics
NPI:1326756461
Name:WEHNER, HAILEY L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:HAILEY
Middle Name:L
Last Name:WEHNER
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 1:7 S ALLIANCE DR STE 211B
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-7297
Mailing Address - Country:US
Mailing Address - Phone:843-553-4383
Mailing Address - Fax:
Practice Address - Street 1:7 S ALLIANCE DR STE 211B
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-7297
Practice Address - Country:US
Practice Address - Phone:843-553-4383
Practice Address - Fax:843-553-4384
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4636363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant