Healthcare Provider Details

I. General information

NPI: 1902560949
Provider Name (Legal Business Name): HALEY RUST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 SUMMER AVE
MEMPHIS TN
38122-5210
US

IV. Provider business mailing address

4710 DURBIN AVE
MEMPHIS TN
38122-4270
US

V. Phone/Fax

Practice location:
  • Phone: 901-416-5952
  • Fax:
Mailing address:
  • Phone: 901-314-2821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: