=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265329296
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HALEY KING
-----------------------------------------------------
Gender |
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2025
-----------------------------------------------------
Last Update Date | 06/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9351 STRAIGHT FRK
-----------------------------------------------------
City | WEST HAMLIN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25571-7508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-617-0772
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9351 STRAIGHT FRK
-----------------------------------------------------
City | WEST HAMLIN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25571-7508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------