Provider Demographics
NPI:1801596929
Name:REYNOLDS, HALEY BETH (CNM)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:BETH
Last Name:REYNOLDS
Suffix:
Gender:
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 MIDDLE CREEK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-5056
Mailing Address - Country:US
Mailing Address - Phone:865-908-9888
Mailing Address - Fax:
Practice Address - Street 1:740 MIDDLE CREEK RD STE 200
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-5056
Practice Address - Country:US
Practice Address - Phone:865-908-9888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-188993163W00000X
TN38267367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ100544Medicaid