Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN272683 | GA |
N | 363LP2300X | Nurse Practitioner - Primary Care | 1-143627 | AL |
N | 363LP2300X | Nurse Practitioner - Primary Care | RN272683 | GA |
NPI | 1053854752 |
---|---|
Provider Name | Haley Vaughan Stapleton |
First Address | Cleveland, GA 30528-2953 |
Second Address | Clayton, GA 30525 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2016 |
Last Update Date | 06/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053854752 | (05) | AL |