Healthcare Provider Details

I. General information

NPI: 1629992029
Provider Name (Legal Business Name): HALEY GIBSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 PARK AVE
FORT SMITH AR
72903-1829
US

IV. Provider business mailing address

472431 E 1125 RD
MULDROW OK
74948-5599
US

V. Phone/Fax

Practice location:
  • Phone: 479-783-4506
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0131306
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: