1669137311 NPI number — MRS. HALEY NOBLES FALKENBERRY

Table of content: MRS. HALEY NOBLES FALKENBERRY (NPI 1669137311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669137311 NPI number — MRS. HALEY NOBLES FALKENBERRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FALKENBERRY
Provider First Name:
HALEY
Provider Middle Name:
NOBLES
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NOBLES
Provider Other First Name:
HALEY
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669137311
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
316 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVERGREEN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36401-3325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-578-2507
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EVERGREEN FAMILY HEALTH CENTER
Provider Second Line Business Practice Location Address:
316 S. MAIN ST
Provider Business Practice Location Address City Name:
EVERGREEN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36401-3325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-578-2507
Provider Business Practice Location Address Fax Number:
251-578-3668
Provider Enumeration Date:
11/07/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  1-155342 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)