Provider Demographics
NPI:1841763968
Name:JOHNSON, HALEY CATHERINE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:CATHERINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 823
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-0823
Mailing Address - Country:US
Mailing Address - Phone:704-894-9309
Mailing Address - Fax:
Practice Address - Street 1:903 NORTHEAST DR STE 301
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-7438
Practice Address - Country:US
Practice Address - Phone:704-894-9309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2024-02-20
Deactivation Date:2019-01-11
Deactivation Code:
Reactivation Date:2020-06-02
Provider Licenses
StateLicense IDTaxonomies
NC0010-101992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-10199OtherNC MEDICAL LICENSE