Healthcare Provider Details

I. General information

NPI: 1356004337
Provider Name (Legal Business Name): HALEY MCCALL JOHNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1698 OLD LEBANON RD
CAMPBELLSVILLE KY
42718-3319
US

IV. Provider business mailing address

1698 OLD LEBANON RD
CAMPBELLSVILLE KY
42718-3319
US

V. Phone/Fax

Practice location:
  • Phone: 270-465-2821
  • Fax:
Mailing address:
  • Phone: 270-465-3561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3016866
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: