Provider Demographics
NPI:1780237859
Name:WILSON, HALEY NEVELS (AGACNP-BC, FNP-BC)
Entity type:Individual
Prefix:MS
First Name:HALEY
Middle Name:NEVELS
Last Name:WILSON
Suffix:
Gender:F
Credentials:AGACNP-BC, FNP-BC
Other - Prefix:MRS
Other - First Name:HALEY
Other - Middle Name:BROOKE
Other - Last Name:NEVELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGACNP-BC, FNP-BC
Mailing Address - Street 1:2501 CITICO AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1127
Mailing Address - Country:US
Mailing Address - Phone:423-697-2000
Mailing Address - Fax:423-697-2320
Practice Address - Street 1:2525 DESALES AVE STE F1009
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1161
Practice Address - Country:US
Practice Address - Phone:423-697-2000
Practice Address - Fax:423-697-2320
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-127930363LA2100X, 363LF0000X
TN34000363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily