MEDICARE: FLORA DENISE GRAY HALEY FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	907636	MS

General Provider Information

NPI Number	:	1124902606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FLORA DENISE GRAY HALEY FNP

Provider Business Mailing Address
First Line	:	2021 ELIZABETH CHAPMAN DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39212-3252
Country	:	US
Telephone Number	:	601-906-9680
Fax Number	:

Provider Business Practice Location Address
First Line	:	2021 ELIZABETH CHAPMAN DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39212-3252
Country	:	US
Telephone Number	:	601-906-9680
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2025
Last Update Date	:	03/20/2026

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