Provider Demographics
NPI:1205504685
Name:FIELLAND, HALEY BRUER (MMS, PA-C)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:BRUER
Last Name:FIELLAND
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:GOLDSTON
Other - Last Name:BRUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2104 FIELDSTONE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772
Mailing Address - Country:US
Mailing Address - Phone:865-803-3773
Mailing Address - Fax:
Practice Address - Street 1:2104 FIELDSTONE DRIVE
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772
Practice Address - Country:US
Practice Address - Phone:865-803-3773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110008096363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1179422OtherNCCPA ID