Healthcare Provider Details

I. General information

NPI: 1255647277
Provider Name (Legal Business Name): HALEY JOHNSTON WOOD W.H.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 08/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 MALLORY LN SUITE 104
FRANKLIN TN
37067-2830
US

IV. Provider business mailing address

1909 MALLORY LN SUITE 104
FRANKLIN TN
37067-2830
US

V. Phone/Fax

Practice location:
  • Phone: 615-771-7718
  • Fax: 615-772-6889
Mailing address:
  • Phone: 615-771-7718
  • Fax: 615-772-6889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number4392P
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: