Provider Demographics
NPI:1629773072
Name:SOUTHERN, HALEIGH (FNP)
Entity type:Individual
Prefix:
First Name:HALEIGH
Middle Name:
Last Name:SOUTHERN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 FRESHRUN DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-4822
Mailing Address - Country:US
Mailing Address - Phone:615-482-3391
Mailing Address - Fax:
Practice Address - Street 1:132 MAPLE ROW BLVD STE 540
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-4786
Practice Address - Country:US
Practice Address - Phone:615-447-3251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37278363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily