Provider Demographics
NPI:1760408322
Name:HALEY, HELEN (FNP)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:HALEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 S MAIN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MONAHANS
Mailing Address - State:TX
Mailing Address - Zip Code:79756-4506
Mailing Address - Country:US
Mailing Address - Phone:432-943-7537
Mailing Address - Fax:432-943-4767
Practice Address - Street 1:405 S MAIN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MONAHANS
Practice Address - State:TX
Practice Address - Zip Code:79756-4506
Practice Address - Country:US
Practice Address - Phone:432-943-7537
Practice Address - Fax:432-943-4767
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX673448363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX673448OtherLICENSE
8B8271Medicare ID - Type Unspecified