Provider Demographics
NPI:1366857559
Name:GILLEN, HALEY (PA-C)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:GILLEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:
Other - Last Name:GORBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 S PLUM ST
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-3346
Mailing Address - Country:US
Mailing Address - Phone:605-677-6700
Mailing Address - Fax:
Practice Address - Street 1:20 S PLUM ST
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-3346
Practice Address - Country:US
Practice Address - Phone:605-677-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1111363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant