Provider Demographics
NPI:1992284293
Name:BASFORD, HALEY (PA)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:BASFORD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18307 OUTLOOK DR
Mailing Address - Street 2:
Mailing Address - City:LOXLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36551-3638
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10040 COUNTY ROAD 48
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-4520
Practice Address - Country:US
Practice Address - Phone:251-220-6780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant