Healthcare Provider Details

I. General information

NPI: 1871324988
Provider Name (Legal Business Name): HALEY STICKLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2024
Last Update Date: 08/10/2024
Certification Date: 08/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5802 NOLENSVILLE PIKE
NASHVILLE TN
37211-6520
US

IV. Provider business mailing address

7345 ALTHORP WAY
NASHVILLE TN
37211-7017
US

V. Phone/Fax

Practice location:
  • Phone: 615-832-5899
  • Fax:
Mailing address:
  • Phone: 586-839-7196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number10965
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: