Healthcare Provider Details

I. General information

NPI: 1548633621
Provider Name (Legal Business Name): HALEY CARLSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N EWING ST
LANCASTER OH
43130-3372
US

IV. Provider business mailing address

362 KELLS CT W
NEWARK OH
43055-4045
US

V. Phone/Fax

Practice location:
  • Phone: 740-687-8000
  • Fax:
Mailing address:
  • Phone: 740-407-3409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.007893RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: