Healthcare Provider Details

I. General information

NPI: 1699239814
Provider Name (Legal Business Name): HALEY RENAE LOCKWOOD APRN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HALEY RENAE SMITH APRN, CNM

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 FLEMINGSBURG RD
MOREHEAD KY
40351-1015
US

IV. Provider business mailing address

555 W SUN ST
MOREHEAD KY
40351-1563
US

V. Phone/Fax

Practice location:
  • Phone: 606-207-2931
  • Fax: 606-783-0964
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number715
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number3016173
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: