Healthcare Provider Details

I. General information

NPI: 1245878487
Provider Name (Legal Business Name): HALEY E JONES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2019
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 OLD LATTA HWY
DILLON SC
29536-7614
US

IV. Provider business mailing address

836 CARROLL RD
LATTA SC
29565-5209
US

V. Phone/Fax

Practice location:
  • Phone: 843-774-4337
  • Fax: 843-774-4373
Mailing address:
  • Phone: 843-845-5242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number224338
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23595
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: