Provider Demographics
NPI:1861640674
Name:MCCAMMON, HALEY R (PA)
Entity Type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:R
Last Name:MCCAMMON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:223 NICIMI DRIVE
Mailing Address - Street 2:PO BOX 73
Mailing Address - City:ELKHART
Mailing Address - State:KS
Mailing Address - Zip Code:67950-0073
Mailing Address - Country:US
Mailing Address - Phone:620-697-2175
Mailing Address - Fax:620-697-2185
Practice Address - Street 1:411 SUNSET ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:KS
Practice Address - Zip Code:67950-5001
Practice Address - Country:US
Practice Address - Phone:620-697-2175
Practice Address - Fax:620-697-2185
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KST-02178363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant