Healthcare Provider Details

I. General information

NPI: 1841554870
Provider Name (Legal Business Name): HAILEY HARDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HAILEY WILLIAMS APRN

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 HOSPITAL DR
MOUNTAIN HOME AR
72653-2955
US

IV. Provider business mailing address

PO BOX 302
CALICO ROCK AR
72519-0302
US

V. Phone/Fax

Practice location:
  • Phone: 870-508-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number221976
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL48992
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: