Provider Demographics
NPI:1417612730
Name:WOOD, HALEA ASHTON
Entity Type:Individual
Prefix:
First Name:HALEA
Middle Name:ASHTON
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 MS HIGHWAY 413
Mailing Address - Street 2:
Mailing Address - City:FRENCH CAMP
Mailing Address - State:MS
Mailing Address - Zip Code:39745-8824
Mailing Address - Country:US
Mailing Address - Phone:662-744-2696
Mailing Address - Fax:
Practice Address - Street 1:2530 MS HIGHWAY 413
Practice Address - Street 2:
Practice Address - City:FRENCH CAMP
Practice Address - State:MS
Practice Address - Zip Code:39745-8824
Practice Address - Country:US
Practice Address - Phone:662-744-2696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program