Provider Demographics
NPI:1730545898
Name:FOLLET, HALEY (MSPAS, PA-C, RD, LD)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:FOLLET
Suffix:
Gender:F
Credentials:MSPAS, PA-C, RD, LD
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:
Other - Last Name:HOOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LD
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-6483
Mailing Address - Fax:682-885-3113
Practice Address - Street 1:1500 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2710
Practice Address - Country:US
Practice Address - Phone:682-885-2140
Practice Address - Fax:817-332-2506
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83853133VN1004X
TXPA16092363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical