Provider Demographics
NPI:1508697855
Name:PORTER KOVAL, HAILEY CORBIN (FNP-BC)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:CORBIN
Last Name:PORTER KOVAL
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 SMITH LN
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-1317
Mailing Address - Country:US
Mailing Address - Phone:850-851-7851
Mailing Address - Fax:
Practice Address - Street 1:214 SMITH LN
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-1317
Practice Address - Country:US
Practice Address - Phone:850-851-7851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11034516363L00000X
PASP031175363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner