Provider Demographics
NPI:1336521616
Name:HALIDAY, MICHAEL (APRN FNP-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HALIDAY
Suffix:
Gender:M
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:HALIDAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1700 OLD LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-9615
Mailing Address - Country:US
Mailing Address - Phone:270-789-6082
Mailing Address - Fax:270-789-6080
Practice Address - Street 1:67 KINGSWOOD DR
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-9647
Practice Address - Country:US
Practice Address - Phone:270-849-2379
Practice Address - Fax:270-789-6119
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009428363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily