Provider Demographics
NPI:1760167381
Name:WILLS, HALEY (LPN)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:WILLS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1987 LONGMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25320-9523
Mailing Address - Country:US
Mailing Address - Phone:304-531-3323
Mailing Address - Fax:
Practice Address - Street 1:4825 MACCORKLE AVE SW STE F
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1365
Practice Address - Country:US
Practice Address - Phone:304-346-9667
Practice Address - Fax:304-346-9717
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV39756164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV236Medicaid
WV568946544OtherBCBS
WV5874OtherHEALTH PARTNERS