MEDICARE: HALEY PEREZ 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
1	363A00000X	Physician Assistant		OK
2	363A00000X	Physician Assistant	4420	OK

General Provider Information

NPI Number	:	1619579802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY PEREZ PA-C

Provider Business Mailing Address
First Line	:	20418 COUNTY ROAD 1600
Second Line	:
City	:	STONEWALL
State	:	OK
Zip	:	74871-6250
Country	:	US
Telephone Number	:	580-949-8079
Fax Number	:	580-272-1335

Provider Business Practice Location Address
First Line	:	1921 STONECIPHER DR
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-3439
Country	:	US
Telephone Number	:	580-436-3980
Fax Number	:	580-272-1335

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

Provider Enumeration Date	:	11/12/2020
Last Update Date	:	01/22/2026

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Directions to “ HALEY PEREZ PA-C” Practice Location

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