Healthcare Provider Details

I. General information

NPI: 1659161800
Provider Name (Legal Business Name): HALEY ANNE SHANNON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2025
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 GOETHALS DR STE 200
RICHLAND WA
99352-3552
US

IV. Provider business mailing address

6607 CHINOOK LN
PASCO WA
99301-8563
US

V. Phone/Fax

Practice location:
  • Phone: 509-942-2555
  • Fax:
Mailing address:
  • Phone: 509-619-4276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP61665468
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: