Provider Demographics
NPI:1770121568
Name:STASICA, HALEY SHOCKLEY (CRNP)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:SHOCKLEY
Last Name:STASICA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:
Other - Last Name:SHOCKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:6727 HIGHWAY 431 S STE L
Mailing Address - Street 2:
Mailing Address - City:OWENS CROSS ROADS
Mailing Address - State:AL
Mailing Address - Zip Code:35763-9226
Mailing Address - Country:US
Mailing Address - Phone:256-564-8900
Mailing Address - Fax:
Practice Address - Street 1:6727 HIGHWAY 431 S STE L
Practice Address - Street 2:
Practice Address - City:OWENS CROSS ROADS
Practice Address - State:AL
Practice Address - Zip Code:35763-9226
Practice Address - Country:US
Practice Address - Phone:256-564-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-135674363LA2100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care