Provider Demographics
NPI:1790357143
Name:HALEY, TIFFANY KATINA
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:KATINA
Last Name:HALEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 FERGUSON MILL RD
Mailing Address - Street 2:
Mailing Address - City:SILVER CREEK
Mailing Address - State:MS
Mailing Address - Zip Code:39663-4435
Mailing Address - Country:US
Mailing Address - Phone:601-754-3978
Mailing Address - Fax:351-205-1434
Practice Address - Street 1:2051 FERGUSON MILL RD
Practice Address - Street 2:
Practice Address - City:SILVER CREEK
Practice Address - State:MS
Practice Address - Zip Code:39663-4435
Practice Address - Country:US
Practice Address - Phone:601-754-3978
Practice Address - Fax:351-205-1434
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No253Z00000XAgenciesIn Home Supportive Care