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General NPI Number Information
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NPI Number | 1710444831
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Entity Type | Individual
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Provider Name | HAYDEN VERL POULSON DPM
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Gender | Male
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Dates
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Enumeration Date | 02/25/2019
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 3200 N WINDSONG DR
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-2255
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Country | US
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Telephone | 866-974-2673
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Fax | 866-939-2673
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Provider Business Mailing Address
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Address Line | 18444 N 25TH AVE STE 310
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City | PHOENIX
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State | AZ
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Zip | 85023-1266
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Country | US
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Telephone | 866-974-2673
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Fax | 866-939-2673
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 11154868-0501
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | POD-000953
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License Number State | AZ
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