Healthcare Provider Details

I. General information

NPI: 1629711783
Provider Name (Legal Business Name): HALEY KATE MARTIN AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HALEY KATE TAYLOR

II. Dates (important events)

Enumeration Date: 04/17/2022
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22915 FAIRLEAF CIR
KATY TX
77494-7530
US

IV. Provider business mailing address

22915 FAIRLEAF CIR
KATY TX
77494-7530
US

V. Phone/Fax

Practice location:
  • Phone: 254-541-0443
  • Fax:
Mailing address:
  • Phone: 254-541-0443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number946028
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1076968
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: