Healthcare Provider Details

I. General information

NPI: 1841763968
Provider Name (Legal Business Name): HALEY CATHERINE JOHNSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date: 01/11/2019
Reactivation Date: 06/02/2020

III. Provider practice location address

903 NORTHEAST DR STE 301
DAVIDSON NC
28036-7438
US

IV. Provider business mailing address

PO BOX 823
DAVIDSON NC
28036-0823
US

V. Phone/Fax

Practice location:
  • Phone: 704-894-9309
  • Fax:
Mailing address:
  • Phone: 704-894-9309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-10199
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: