Provider Demographics
NPI:1629726708
Name:BURTON, HAILEY DIANA (FNP-C)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:DIANA
Last Name:BURTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:HAILEY
Other - Middle Name:DIANA
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:18206 BARTONS RUN TRCE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37090-2557
Mailing Address - Country:US
Mailing Address - Phone:615-428-0964
Mailing Address - Fax:
Practice Address - Street 1:13181 OLD NASHVILLE HWY STE 150
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-4034
Practice Address - Country:US
Practice Address - Phone:615-355-5105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30844363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily