Healthcare Provider Details

I. General information

NPI: 1861364325
Provider Name (Legal Business Name): HALEY KILLIAN APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 SAN ANTONIO AVE
MANY LA
71449-3227
US

IV. Provider business mailing address

628 NORTH LOOP
HORNBECK LA
71439-1510
US

V. Phone/Fax

Practice location:
  • Phone: 318-431-5100
  • Fax: 318-808-7007
Mailing address:
  • Phone: 318-431-5100
  • Fax: 318-808-7007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2203784767
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: