Provider Demographics
NPI:1649032707
Name:BATES, HALEIGH HANNA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:HALEIGH
Middle Name:HANNA
Last Name:BATES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:HALEIGH
Other - Middle Name:HANNA
Other - Last Name:PUCHEU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1607 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7345
Mailing Address - Country:US
Mailing Address - Phone:769-300-2100
Mailing Address - Fax:
Practice Address - Street 1:1607 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-7345
Practice Address - Country:US
Practice Address - Phone:769-300-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MSPA00786363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant