Provider Demographics
NPI:1548859861
Name:GEORGE, HALEY RENEE
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:RENEE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:RENEE
Other - Last Name:QUISENBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 451
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73648-0451
Mailing Address - Country:US
Mailing Address - Phone:802-430-9395
Mailing Address - Fax:
Practice Address - Street 1:2900 W 3RD ST
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-4324
Practice Address - Country:US
Practice Address - Phone:580-243-0939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK001318390200000X
OK1318237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK001318OtherOKLAHOMA STATE DEPARTMENT OF HEALTH HEARING AID DEALER AND FITTER