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NPI Code Detail

MEDICARE: HALEY POOL CPNP-PC

MEDICARE: HALEY POOL CPNP-PC
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
1208000000XPediatrics Physician1056807TX

General Provider Information

NPI Number : 1881356384
Entity Type Code : Individual
Provider Name (Legal Business Name) : HALEY POOL CPNP-PC
Provider Business Mailing Address
First Line : 1205 N 6TH ST
Second Line :
City : LONGVIEW
State : TX
Zip : 75601-5539
Country : US
Telephone Number : 903-230-0235
Fax Number :
Provider Business Practice Location Address
First Line : 1205 N 6TH ST
Second Line :
City : LONGVIEW
State : TX
Zip : 75601-5539
Country : US
Telephone Number : 903-230-0235
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2021
Last Update Date : 10/12/2021

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Directions to “ HALEY POOL CPNP-PC” Practice Location

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