MEDICARE: HAILEY COUNTRYMAN

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	374J00000X	Doula

General Provider Information

NPI Number	:	1639031149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAILEY COUNTRYMAN

Provider Business Mailing Address
First Line	:	7227 CHURCH ST
Second Line	:
City	:	PENRYN
State	:	CA
Zip	:	95663-9411
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9399 MADISON AVE STE 103
Second Line	:
City	:	ORANGEVALE
State	:	CA
Zip	:	95662-4976
Country	:	US
Telephone Number	:	916-827-5571
Fax Number	:	916-827-5571

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

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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Directions to “ HAILEY COUNTRYMAN ” Practice Location

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