Provider Demographics
NPI:1578820346
Name:GONZALEZ, HALEY ELIZABETH (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:ELIZABETH
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:MISS
Other - First Name:HALEY
Other - Middle Name:
Other - Last Name:HAMPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 SAINT CHARLES CT
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-7958
Mailing Address - Country:US
Mailing Address - Phone:501-276-1342
Mailing Address - Fax:
Practice Address - Street 1:216 GARRISON ST STE B
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-7319
Practice Address - Country:US
Practice Address - Phone:501-276-1342
Practice Address - Fax:501-463-4042
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2023-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1179133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered