Provider Demographics
NPI:1689134629
Name:FRIZZELL, HALEY (PA)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:FRIZZELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 W CUTHBERT AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-3887
Mailing Address - Country:US
Mailing Address - Phone:432-687-0311
Mailing Address - Fax:432-687-0312
Practice Address - Street 1:2706 W CUTHBERT AVE STE C
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-3887
Practice Address - Country:US
Practice Address - Phone:432-687-0311
Practice Address - Fax:432-687-0312
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12670363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical