Provider Demographics
NPI:1417673401
Name:HOUTCHENS, HALEY MARILYN
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:MARILYN
Last Name:HOUTCHENS
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 1:1450 DEXTER ST # 160
Mailing Address - Street 2:
Mailing Address - City:FORT LUPTON
Mailing Address - State:CO
Mailing Address - Zip Code:80621-1503
Mailing Address - Country:US
Mailing Address - Phone:303-857-7873
Mailing Address - Fax:
Practice Address - Street 1:1450 DEXTER ST # 160
Practice Address - Street 2:
Practice Address - City:FORT LUPTON
Practice Address - State:CO
Practice Address - Zip Code:80621-1503
Practice Address - Country:US
Practice Address - Phone:303-857-7873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0998113-NP363L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program