Provider Demographics
NPI:1619615028
Name:BIRKENHOLZ, HALEIGH MARIE (CAA)
Entity Type:Individual
Prefix:
First Name:HALEIGH
Middle Name:MARIE
Last Name:BIRKENHOLZ
Suffix:
Gender:F
Credentials:CAA
Other - Prefix:
Other - First Name:HALEIGH
Other - Middle Name:
Other - Last Name:PLYMELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:609 W BRYANT ST
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-8346
Mailing Address - Country:US
Mailing Address - Phone:660-334-0800
Mailing Address - Fax:
Practice Address - Street 1:3801 S NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5210
Practice Address - Country:US
Practice Address - Phone:417-269-4557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO32698122367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant