| Provider / Organization | NPI | Date Certified |
|---|---|---|
| SAMANTHA JO HALEY | 1285281758 | 2019-08-20 |
Samantha Jo Haley [F] graduated in 2019 and primarily specializes in Nurse Practitioner.
Samantha Jo Haley is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1285281758. Registration indicates Samantha Jo Haley is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Nurse Practitioner: Family, ) (All Other Specialties & Provider Types, ) (Nurse Practitioner Family, Physician Assistants & Advanced Practice Nursing Providers) (Nurse Practitioner, )
| PECOS ID | 4284044363 |
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Samantha Jo Haley FNP-C |
| Practice Office Address | 7200 SW 45TH AVE UNIT 14 AMARILLO, TX US |
| Practice Office Telephone | 8066801900 |
| Practice Office Fax | 8065136791 |
| Mailing Address | 367 S GULPH RD ATN :IPM CREDENTIALING KING OF PRUSSIA, PA 194063121 US |
| Business Telephone | 8066801900 |
| Business Fax | 8065136791 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 6842 Plum Creek Dr | Amarillo, TX 791241601 | 8063530007 |
| 2001 S. Coulter St Suite 2001 | Amarillo, TX 791062521 | 8063185777 / 8065136926 |
| 301 North 23rd Street Suite C | Canyon, TX 790153028 | 8064525522 / 8064523070 |
| Code | Practice | License No State |
|---|---|---|
| 363LF0000X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse PractitionerAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Nurse Practitioner: Family All Other Specialties & Provider Types Nurse Practitioner Family Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | AP142093
TX |
| 1K9944 | OTHER | TX | PTAN |