Healthcare Provider Details

I. General information

NPI: 1093258527
Provider Name (Legal Business Name): HALEY BROOKE CANNADY N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2016
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 OMNI DR STE B
SENECA SC
29672-9448
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-888-4222
  • Fax: 864-888-0023
Mailing address:
  • Phone: 864-522-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number20549
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: