Provider Demographics
NPI:1578955159
Name:MAXON, HALEY ELIZABETH (FNP)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:ELIZABETH
Last Name:MAXON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:ELIZABETH
Other - Last Name:HOTMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 W 22ND ST
Mailing Address - Street 2:
Mailing Address - City:HIGGINSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64037-1420
Mailing Address - Country:US
Mailing Address - Phone:660-262-7751
Mailing Address - Fax:
Practice Address - Street 1:1200 W 22ND ST
Practice Address - Street 2:
Practice Address - City:HIGGINSVILLE
Practice Address - State:MO
Practice Address - Zip Code:64037-1420
Practice Address - Country:US
Practice Address - Phone:660-584-7751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014044172363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily