Provider Demographics
NPI:1255080453
Name:MARTIN, HAILEE ANN (PA-C)
Entity type:Individual
Prefix:
First Name:HAILEE
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2400
Mailing Address - Street 2:
Mailing Address - City:SURF CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28445-0027
Mailing Address - Country:US
Mailing Address - Phone:910-329-9916
Mailing Address - Fax:910-329-9919
Practice Address - Street 1:2540 NC HIGHWAY 210 E
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-8988
Practice Address - Country:US
Practice Address - Phone:910-329-9916
Practice Address - Fax:910-329-9919
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC0010-12597207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program