Provider Demographics
NPI:1619787389
Name:SMITH, HALEY M
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3184 E COUNTY ROAD 1200 S
Mailing Address - Street 2:
Mailing Address - City:CLOVERDALE
Mailing Address - State:IN
Mailing Address - Zip Code:46120-8541
Mailing Address - Country:US
Mailing Address - Phone:765-721-3365
Mailing Address - Fax:
Practice Address - Street 1:3184 E COUNTY ROAD 1200 S
Practice Address - Street 2:
Practice Address - City:CLOVERDALE
Practice Address - State:IN
Practice Address - Zip Code:46120-8541
Practice Address - Country:US
Practice Address - Phone:765-721-3365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant