Provider Demographics
NPI:1629711783
Name:MARTIN, HALEY KATE (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:KATE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:KATE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22915 FAIRLEAF CIR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7530
Mailing Address - Country:US
Mailing Address - Phone:254-541-0443
Mailing Address - Fax:
Practice Address - Street 1:22915 FAIRLEAF CIR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7530
Practice Address - Country:US
Practice Address - Phone:254-541-0443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-17
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX946028163WG0600X
TX1076968363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WG0600XNursing Service ProvidersRegistered NurseGerontology