Basic Information
| Provider Information | |||||||||
| NPI: | 1336521616 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALIDAY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | |||||||||
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| Credential: | APRN FNP-C | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | HALIDAY | ||||||||
| OtherFirstName: | MIKE | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1700 OLD LEBANON RD | ||||||||
| Address2: | |||||||||
| City: | CAMPBELLSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427189615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707896082 | ||||||||
| FaxNumber: | 2707896080 | ||||||||
| Practice Location | |||||||||
| Address1: | 67 KINGSWOOD DR | ||||||||
| Address2: | |||||||||
| City: | CAMPBELLSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427189647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708492379 | ||||||||
| FaxNumber: | 2707896119 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2015 | ||||||||
| LastUpdateDate: | 05/18/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 3009428 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.