Provider Demographics
NPI:1396308102
Name:HALEY, KAILEY MADISON (DO)
Entity type:Individual
Prefix:MRS
First Name:KAILEY
Middle Name:MADISON
Last Name:HALEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:KAILEY
Other - Middle Name:MADISON
Other - Last Name:SHULER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8307 E GREELEY PL
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-2730
Mailing Address - Country:US
Mailing Address - Phone:405-315-8716
Mailing Address - Fax:
Practice Address - Street 1:19600 E ROSS ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-0545
Practice Address - Country:US
Practice Address - Phone:539-234-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6981208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics