Provider Demographics
NPI:1720753122
Name:HOUGH, HALEY (PA-C)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:HOUGH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:
Other - Last Name:SCHANER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:701 PINNACLE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-6228
Mailing Address - Country:US
Mailing Address - Phone:402-505-7989
Mailing Address - Fax:402-932-8863
Practice Address - Street 1:13616 CALIFORNIA ST STE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-5336
Practice Address - Country:US
Practice Address - Phone:402-496-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2559363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical