Provider Demographics
NPI:1508610023
Name:HAILEY, JESSE SHARP
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:SHARP
Last Name:HAILEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 COUNTY ROAD 1615
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-6848
Mailing Address - Country:US
Mailing Address - Phone:205-493-1288
Mailing Address - Fax:
Practice Address - Street 1:61 COUNTY ROAD 1615
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-6848
Practice Address - Country:US
Practice Address - Phone:205-493-1288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-176760163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine