Healthcare Provider Details

I. General information

NPI: 1043133960
Provider Name (Legal Business Name): HAYLEY KRISTA MOLL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16091 W DESERT LN
SURPRISE AZ
85374-7851
US

IV. Provider business mailing address

21402 W MINNEZONA AVE
BUCKEYE AZ
85396-1325
US

V. Phone/Fax

Practice location:
  • Phone: 757-279-8801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-367191
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: