Provider Demographics
NPI:1891951794
Name:CROUCH, HALEY DOTSON (PA)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:DOTSON
Last Name:CROUCH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:HALEY
Other - Middle Name:ERIN
Other - Last Name:DOTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:534 WOODS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607
Mailing Address - Country:US
Mailing Address - Phone:864-720-2739
Mailing Address - Fax:864-720-2730
Practice Address - Street 1:534 WOODS LAKE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607
Practice Address - Country:US
Practice Address - Phone:864-720-2739
Practice Address - Fax:864-720-2740
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1329207K00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1040PAMedicaid
SCAA49307951Medicare PIN