Healthcare Provider Details

I. General information

NPI: 1962970343
Provider Name (Legal Business Name): HALEY LAENE BOHL MEJIAS MMS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S PHELPS DR
APACHE JUNCTION AZ
85120-6700
US

IV. Provider business mailing address

300 S PHELPS DR
APACHE JUNCTION AZ
85120-6700
US

V. Phone/Fax

Practice location:
  • Phone: 480-536-6850
  • Fax:
Mailing address:
  • Phone: 480-536-6850
  • Fax: 602-834-1592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7305
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: