Provider Demographics
NPI:1477265163
Name:HALE, HALEY KATHRYN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:KATHRYN
Last Name:HALE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:HALEY
Other - Middle Name:KATHRYN
Other - Last Name:HALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5704 LEDGESTONE DR
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-7269
Mailing Address - Country:US
Mailing Address - Phone:405-397-2385
Mailing Address - Fax:
Practice Address - Street 1:160 E SW 59TH ST
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-4722
Practice Address - Country:US
Practice Address - Phone:405-397-2385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK211063363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNA