Healthcare Provider Details

I. General information

NPI: 1962204933
Provider Name (Legal Business Name): HALEY BRINKLEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HALEY BARWICK

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 WILLIAMSON COUNTY PKWY
MARION IL
62959-5235
US

IV. Provider business mailing address

109 CALIFORNIA ST PO BOX 577
CARTERVILLE IL
62918
US

V. Phone/Fax

Practice location:
  • Phone: 618-519-9200
  • Fax: 618-985-9155
Mailing address:
  • Phone: 618-519-9200
  • Fax: 618-985-4635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.032006
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: