Provider Demographics
NPI:1972674646
Name:HALEY, LADONNA JOAN (RN MS MN APN CNS PMH)
Entity Type:Individual
Prefix:MS
First Name:LADONNA
Middle Name:JOAN
Last Name:HALEY
Suffix:
Gender:F
Credentials:RN MS MN APN CNS PMH
Other - Prefix:
Other - First Name:LADONNA
Other - Middle Name:JOAN
Other - Last Name:HOFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3060
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573
Mailing Address - Country:US
Mailing Address - Phone:956-583-8815
Mailing Address - Fax:956-583-2436
Practice Address - Street 1:1605 EAST GRIFFIN PARKWAY
Practice Address - Street 2:D
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572
Practice Address - Country:US
Practice Address - Phone:956-583-8815
Practice Address - Fax:956-583-2436
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP106339364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029327601Medicaid
NP0070Medicare ID - Type Unspecified
TX029327601Medicaid