Healthcare Provider Details

I. General information

NPI: 1265379408
Provider Name (Legal Business Name): HAILEY JORDAN FLETCHER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 MIMOSA DR
THOMASVILLE GA
31792-6605
US

IV. Provider business mailing address

171 TIMBER RIDGE DR
THOMASVILLE GA
31757-4830
US

V. Phone/Fax

Practice location:
  • Phone: 229-584-5570
  • Fax:
Mailing address:
  • Phone: 478-595-7436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1265379408
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: