Provider Demographics
NPI:1912418575
Name:BLUE, HALEY AUSTIN MIDKIFF (ATC,LAT)
Entity Type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:AUSTIN MIDKIFF
Last Name:BLUE
Suffix:
Gender:F
Credentials:ATC,LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18824 COLLINS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DAWSON SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42408-9222
Mailing Address - Country:US
Mailing Address - Phone:270-339-7410
Mailing Address - Fax:
Practice Address - Street 1:500 CLINIC DR
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-4991
Practice Address - Country:US
Practice Address - Phone:270-707-3387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-22
Last Update Date:2017-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT12542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer