Provider Demographics
NPI:1750971800
Name:BLACK, HAYLEY ALYSSA (FNP-C)
Entity type:Individual
Prefix:
First Name:HAYLEY
Middle Name:ALYSSA
Last Name:BLACK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:HAYLEY
Other - Middle Name:ALYSSA
Other - Last Name:HAMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 ALCORN DR STE 2C
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-9073
Mailing Address - Country:US
Mailing Address - Phone:662-293-7618
Mailing Address - Fax:662-293-4358
Practice Address - Street 1:703 ALCORN DR STE 109
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9302
Practice Address - Country:US
Practice Address - Phone:662-286-1499
Practice Address - Fax:662-286-9041
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904395363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily