Healthcare Provider Details

I. General information

NPI: 1245658533
Provider Name (Legal Business Name): JEREMY ALLEN HAYSLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 SUGAR MAPLE DR 88 MEDICAL GROUP/88 SGC
WRIGHT PATTERSON AFB OH
45433-5529
US

IV. Provider business mailing address

589 GARDEN DR
LOUISVILLE KY
40206-2966
US

V. Phone/Fax

Practice location:
  • Phone: 937-257-0837
  • Fax:
Mailing address:
  • Phone: 502-727-1021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number52648
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35.137187
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01088956A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: