Healthcare Provider Details

I. General information

NPI: 1386264034
Provider Name (Legal Business Name): HAYLEY OLIVIA DETTLINGER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HAYLEY KNIFLEY

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 EDMONTON RD
COLUMBIA KY
42728-8467
US

IV. Provider business mailing address

3050 EDMONTON RD
COLUMBIA KY
42728-8467
US

V. Phone/Fax

Practice location:
  • Phone: 270-250-3990
  • Fax:
Mailing address:
  • Phone: 270-250-3990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3017400
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number1160950
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: