Provider Demographics
NPI:1366037038
Name:DAVID, HALEY B (FNP)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:B
Last Name:DAVID
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:MICHELLE
Other - Last Name:BLANCHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 395
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70722-0395
Mailing Address - Country:US
Mailing Address - Phone:225-683-5292
Mailing Address - Fax:225-683-1310
Practice Address - Street 1:203 ALLENDALE DR
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767-3219
Practice Address - Country:US
Practice Address - Phone:225-389-1311
Practice Address - Fax:225-389-1330
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA218162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA218162OtherPRACTICING LICENSE