Provider Demographics
NPI:1528430865
Name:BRENNAN, HALEY DIANE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:DIANE
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:HALEY
Other - Middle Name:DIANE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4705 BRIARWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-2639
Mailing Address - Country:US
Mailing Address - Phone:325-054-1454
Mailing Address - Fax:833-941-0864
Practice Address - Street 1:4705 BRIARWOOD AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-2639
Practice Address - Country:US
Practice Address - Phone:325-054-1454
Practice Address - Fax:833-941-0864
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10201363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical