Provider Demographics
NPI:1730740911
Name:COORS, HALEY NICOLE
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:NICOLE
Last Name:COORS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 RUSHING CIR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-2637
Mailing Address - Country:US
Mailing Address - Phone:501-697-8365
Mailing Address - Fax:
Practice Address - Street 1:1604 RUSHING CIR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-2637
Practice Address - Country:US
Practice Address - Phone:501-697-8365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty