Provider Demographics
NPI:1649731829
Name:KNIGHT, HALEY SHALEIGH
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:SHALEIGH
Last Name:KNIGHT
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 1:809 COUNTY HIGHWAY 21
Mailing Address - Street 2:
Mailing Address - City:GUIN
Mailing Address - State:AL
Mailing Address - Zip Code:35563-4114
Mailing Address - Country:US
Mailing Address - Phone:205-495-1376
Mailing Address - Fax:
Practice Address - Street 1:15225 HIGHWAY 43 STE I
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-1969
Practice Address - Country:US
Practice Address - Phone:256-331-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-128248363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily