Healthcare Provider Details

I. General information

NPI: 1073202057
Provider Name (Legal Business Name): HALEY WHITNEY CARROLL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 W 5TH ST STE 300
LONDON KY
40741-1688
US

IV. Provider business mailing address

1406 W 5TH ST STE 300
LONDON KY
40741-1688
US

V. Phone/Fax

Practice location:
  • Phone: 606-526-4970
  • Fax: 606-526-4971
Mailing address:
  • Phone: 606-526-4970
  • Fax: 606-526-4971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTP184
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: