Healthcare Provider Details

I. General information

NPI: 1871116343
Provider Name (Legal Business Name): HALEY ALEXA POWELL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 GRESHAM DR
NORFOLK VA
23507
US

IV. Provider business mailing address

401 GRESHAM DR
NORFOLK VA
23507
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-7850
  • Fax:
Mailing address:
  • Phone: 757-668-7850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number0102208668
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: