Healthcare Provider Details

I. General information

NPI: 1174194864
Provider Name (Legal Business Name): HALEY WALKER EVERETT AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2021
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4207 BURNET RD
AUSTIN TX
78756-3316
US

IV. Provider business mailing address

1818 CATTLE DR
CEDAR PARK TX
78613-1489
US

V. Phone/Fax

Practice location:
  • Phone: 512-706-1900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1041044
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1041044
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1041044
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: