Provider Demographics
NPI:1710674189
Name:JOHNSON, HALEY (PMHNP)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 ROBBINS DR
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-3229
Mailing Address - Country:US
Mailing Address - Phone:662-587-3766
Mailing Address - Fax:
Practice Address - Street 1:297 COUNTY ROAD 244
Practice Address - Street 2:
Practice Address - City:ETTA
Practice Address - State:MS
Practice Address - Zip Code:38627-9523
Practice Address - Country:US
Practice Address - Phone:662-281-9992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS9058032084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry