Healthcare Provider Details

I. General information

NPI: 1508610023
Provider Name (Legal Business Name): JESSE SHARP HAILEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2024
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 S MAIN ST
ARAB AL
35016-1394
US

IV. Provider business mailing address

20 S MAIN ST
ARAB AL
35016-1394
US

V. Phone/Fax

Practice location:
  • Phone: 833-586-2324
  • Fax:
Mailing address:
  • Phone: 205-493-1288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-176760
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: