Healthcare Provider Details

I. General information

NPI: 1194639955
Provider Name (Legal Business Name): HAYLEI JAE HALLIBURTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 MELROSE AVE
NASHVILLE TN
37211-2161
US

IV. Provider business mailing address

951 BRITTANY PARK DR APT 520
ANTIOCH TN
37013-6023
US

V. Phone/Fax

Practice location:
  • Phone: 615-832-8955
  • Fax:
Mailing address:
  • Phone: 931-627-9535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-388204
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: