Provider Demographics
NPI:1376260380
Name:HEACOCK, HALEY CATHLEEN (RN)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:CATHLEEN
Last Name:HEACOCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7114 SHEFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2530
Mailing Address - Country:US
Mailing Address - Phone:865-606-1212
Mailing Address - Fax:
Practice Address - Street 1:7114 SHEFFIELD DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2530
Practice Address - Country:US
Practice Address - Phone:865-606-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN255236163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse