Healthcare Provider Details

I. General information

NPI: 1326567595
Provider Name (Legal Business Name): HALEIGH JOEST FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 07/21/2022
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 STATE LINE RD
COLCORD OK
74338
US

IV. Provider business mailing address

644 STATE LINE RD
COLCORD OK
74338
US

V. Phone/Fax

Practice location:
  • Phone: 918-203-0004
  • Fax: 918-856-5554
Mailing address:
  • Phone: 918-203-0004
  • Fax: 918-856-5554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number22886
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number202229
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: