Provider Demographics
NPI:1932789948
Name:BRAGG, HALEY NICOLE
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:NICOLE
Last Name:BRAGG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 HEDRICK ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-4144
Mailing Address - Country:US
Mailing Address - Phone:304-575-0879
Mailing Address - Fax:
Practice Address - Street 1:129 HEDRICK ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4144
Practice Address - Country:US
Practice Address - Phone:304-575-0879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant