Healthcare Provider Details

I. General information

NPI: 1326253857
Provider Name (Legal Business Name): HALEY KUHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 VETERANS MEMORIAL DR
KOSCIUSKO MS
39090-3849
US

IV. Provider business mailing address

202 FAIRWAY LN
KOSCIUSKO MS
39090-4603
US

V. Phone/Fax

Practice location:
  • Phone: 769-777-4400
  • Fax: 769-777-4401
Mailing address:
  • Phone: 601-250-4815
  • Fax: 601-250-6859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3190
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: