Provider Demographics
NPI:1487035069
Name:LIU, HAYLEY (APRN)
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:HAYLEY
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:100 EAST LIBERTY
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1438
Mailing Address - Country:US
Mailing Address - Phone:502-540-3339
Mailing Address - Fax:502-479-1425
Practice Address - Street 1:5129 DIXIE HWY STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-1727
Practice Address - Country:US
Practice Address - Phone:502-447-3338
Practice Address - Fax:502-595-7007
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009423363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100358270Medicaid
KYK159411OtherMEDICARE
KYK159410Medicare PIN