Healthcare Provider Details

I. General information

NPI: 1366294084
Provider Name (Legal Business Name): HALEY J HICKERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8308 OHIO RIVER RD STE B
WHEELERSBURG OH
45694-1713
US

IV. Provider business mailing address

8308 OHIO RIVER RD STE B
WHEELERSBURG OH
45694-1713
US

V. Phone/Fax

Practice location:
  • Phone: 740-529-1201
  • Fax:
Mailing address:
  • Phone: 740-529-1201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.514397
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: