Provider Demographics
NPI:1114739307
Name:REID, HALEY RAQUEL
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:RAQUEL
Last Name:REID
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:RAQUEL
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HALEY RAQUEL GARLAND
Mailing Address - Street 1:1633 W MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-3875
Mailing Address - Country:US
Mailing Address - Phone:423-492-7100
Mailing Address - Fax:423-586-9347
Practice Address - Street 1:1633 W MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-3875
Practice Address - Country:US
Practice Address - Phone:423-492-7100
Practice Address - Fax:423-586-9347
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38043363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ099686Medicaid