Provider Demographics
NPI:1346930575
Name:MAYFIELD, HALEY DYAN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:DYAN
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4326 N WOODLAWN CT
Mailing Address - Street 2:
Mailing Address - City:BEL AIRE
Mailing Address - State:KS
Mailing Address - Zip Code:67220-3850
Mailing Address - Country:US
Mailing Address - Phone:620-521-7262
Mailing Address - Fax:
Practice Address - Street 1:4326 N WOODLAWN CT
Practice Address - Street 2:
Practice Address - City:BEL AIRE
Practice Address - State:KS
Practice Address - Zip Code:67220-3850
Practice Address - Country:US
Practice Address - Phone:620-521-7262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
KS15-02814363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant