Healthcare Provider Details

I. General information

NPI: 1548603095
Provider Name (Legal Business Name): HALEY FULLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTON CHILDREN'S HOSPITAL 231 E CHESTNUT ST
LOUISVILLE KY
40202-1821
US

IV. Provider business mailing address

231 E CHESTNUT ST
LOUISVILLE KY
40202-1821
US

V. Phone/Fax

Practice location:
  • Phone: 502-451-9949
  • Fax: 502-451-4553
Mailing address:
  • Phone: 502-629-4900
  • Fax: 502-629-4237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberTP832
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number51836
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: