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NPI Code Detail

MEDICARE: MRS. HALEY DIANE BRENNAN PA-C

MEDICARE: MRS. HALEY DIANE BRENNAN PA-C
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
1363AM0700XMedical Physician AssistantPA10201TX

General Provider Information

NPI Number : 1528430865
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. HALEY DIANE BRENNAN PA-C
Provider Business Mailing Address
First Line : 4705 BRIARWOOD AVE
Second Line :
City : MIDLAND
State : TX
Zip : 79707-2639
Country : US
Telephone Number : 325-054-1454
Fax Number : 833-941-0864
Provider Business Practice Location Address
First Line : 4705 BRIARWOOD AVE
Second Line :
City : MIDLAND
State : TX
Zip : 79707-2639
Country : US
Telephone Number : 325-054-1454
Fax Number : 833-941-0864
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2015
Last Update Date : 03/10/2025

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Directions to “ MRS. HALEY DIANE BRENNAN PA-C” Practice Location

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