Provider Demographics
NPI:1548603095
Name:FULLER, HALEY (MD)
Entity Type:Individual
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First Name:HALEY
Middle Name:
Last Name:FULLER
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Gender:F
Credentials:MD
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Mailing Address - Street 1:PEDIATRIC ANAESTHESIA ASSOCIATES PSC
Mailing Address - Street 2:3812 TAYLORSVILLE RD
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1304
Mailing Address - Country:US
Mailing Address - Phone:502-451-9949
Mailing Address - Fax:502-451-4553
Practice Address - Street 1:NORTON CHILDREN'S HOSPITAL
Practice Address - Street 2:231 E CHESTNUT ST
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1821
Practice Address - Country:US
Practice Address - Phone:502-451-9949
Practice Address - Fax:502-451-4553
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2023-08-29
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Provider Licenses
StateLicense IDTaxonomies
KYTP832207LP3000X
KY51836207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology