Healthcare Provider Details

I. General information

NPI: 1699465930
Provider Name (Legal Business Name): HAILEY NEWBERRY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 W QUINCY AVE
CLOVIS CA
93619-4813
US

IV. Provider business mailing address

477 W QUINCY AVE
CLOVIS CA
93619-4813
US

V. Phone/Fax

Practice location:
  • Phone: 559-299-3655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: