Provider Demographics
NPI:1891397626
Name:KAELIN, HAYLEY WATSON
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:WATSON
Last Name:KAELIN
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 1:9402 S 325 W
Mailing Address - Street 2:
Mailing Address - City:WAVELAND
Mailing Address - State:IN
Mailing Address - Zip Code:47989-8158
Mailing Address - Country:US
Mailing Address - Phone:765-577-1579
Mailing Address - Fax:
Practice Address - Street 1:709 S 18TH ST STE C
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-1572
Practice Address - Country:US
Practice Address - Phone:765-709-0500
Practice Address - Fax:765-709-9720
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28194611A163WC0400X
IN71011209A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management