Provider Demographics
NPI:1194492827
Name:PETERS, HALEY C (FNP-BC)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:C
Last Name:PETERS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246A FOREST DR
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2914
Mailing Address - Country:US
Mailing Address - Phone:406-871-9987
Mailing Address - Fax:
Practice Address - Street 1:160 HERITAGE WAY STE 103
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3127
Practice Address - Country:US
Practice Address - Phone:406-871-6226
Practice Address - Fax:406-758-7925
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-177754363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTNUR-APRN-LIC-177754OtherAPRN LICENSE NUMBER