Provider Demographics
NPI:1598409021
Name:ROOZEBOOM, HAILEY LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:LYNN
Last Name:ROOZEBOOM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HAILEY
Other - Middle Name:LYNN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:223 S WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-6974
Mailing Address - Country:US
Mailing Address - Phone:515-368-7504
Mailing Address - Fax:515-355-3491
Practice Address - Street 1:223 S WALNUT AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6974
Practice Address - Country:US
Practice Address - Phone:515-368-7504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA121657363LP0808X
IA1202593363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical