Healthcare Provider Details

I. General information

NPI: 1508320078
Provider Name (Legal Business Name): HALEY HERNDON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2327 NEW HOLT RD
PADUCAH KY
42001-7404
US

IV. Provider business mailing address

5050 VILLAGE SQUARE DR STE B
PADUCAH KY
42001-7552
US

V. Phone/Fax

Practice location:
  • Phone: 270-534-5128
  • Fax: 270-477-0007
Mailing address:
  • Phone: 270-534-5128
  • Fax: 270-477-0007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2476
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2476
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA2476
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: