Provider Demographics
NPI:1457056186
Name:CHURCH, HAYLEY HERTEL-CHRISTIAN (NP)
Entity Type:Individual
Prefix:MRS
First Name:HAYLEY
Middle Name:HERTEL-CHRISTIAN
Last Name:CHURCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 JOHNSTON DR
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28134-8539
Mailing Address - Country:US
Mailing Address - Phone:704-995-2788
Mailing Address - Fax:
Practice Address - Street 1:165 AMENDMENT AVE # 102
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3036
Practice Address - Country:US
Practice Address - Phone:803-329-2700
Practice Address - Fax:803-329-2788
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27238363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics