Provider Demographics
NPI:1770929036
Name:MOLLARD, HAYLEY DAWN (PA-C)
Entity type:Individual
Prefix:
First Name:HAYLEY
Middle Name:DAWN
Last Name:MOLLARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HAYLEY
Other - Middle Name:DAWN
Other - Last Name:HOUSE AND KEMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5121 S COTTONWOOD ST
Mailing Address - Street 2:TRAUMA SERVICES
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5701
Mailing Address - Country:US
Mailing Address - Phone:801-599-1531
Mailing Address - Fax:
Practice Address - Street 1:5121 COTTONWOOD STREET
Practice Address - Street 2:TRAUMA SERVICES
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84121-7552
Practice Address - Country:US
Practice Address - Phone:801-599-1531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8447955-1206363AS0400X, 363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical