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General NPI Number Information
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NPI Number | 1568929552
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Entity Type | Individual
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Provider Name | HALEY MARTIN
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Gender | Female
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Dates
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Enumeration Date | 02/26/2019
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 1048 ALEDO RIDGE CT
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City | FORT WORTH
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State | TX
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Zip | 76108-3098
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Country | US
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Telephone | 817-694-5232
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Fax | 817-441-9282
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Provider Business Mailing Address
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Address Line | 1048 ALEDO RIDGE CT
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City | FORT WORTH
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State | TX
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Zip | 76108-3098
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Country | US
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Telephone | 817-694-5232
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Fax | 817-441-9282
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | AP140445
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP140445
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License Number State | TX
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