Provider Demographics
NPI:1982405916
Name:HALEY, ANGELA DAWN (ST)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAWN
Last Name:HALEY
Suffix:
Gender:
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14731 W 17TH ST S
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-4410
Mailing Address - Country:US
Mailing Address - Phone:918-900-3828
Mailing Address - Fax:
Practice Address - Street 1:14731 W 17TH ST S
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-4410
Practice Address - Country:US
Practice Address - Phone:918-900-3828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist