Provider Demographics
NPI:1265922454
Name:MCCARTER, HAILEY (CRNA)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:MCCARTER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:HAILEY
Other - Middle Name:
Other - Last Name:MCGILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 PROVIDENCE POINT LN
Mailing Address - Street 2:
Mailing Address - City:WELLFORD
Mailing Address - State:SC
Mailing Address - Zip Code:29385-9232
Mailing Address - Country:US
Mailing Address - Phone:803-517-8056
Mailing Address - Fax:
Practice Address - Street 1:720 N PINE ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3127
Practice Address - Country:US
Practice Address - Phone:864-504-3555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC121607367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered