Provider Demographics
NPI:1730837188
Name:GADDIS, HAILEY DAWN
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:DAWN
Last Name:GADDIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 W 4175 S APT SUITE
Mailing Address - Street 2:
Mailing Address - City:HOOPER
Mailing Address - State:UT
Mailing Address - Zip Code:84315-9639
Mailing Address - Country:US
Mailing Address - Phone:801-814-0570
Mailing Address - Fax:
Practice Address - Street 1:5230 W 4175 S APT SUITE
Practice Address - Street 2:
Practice Address - City:HOOPER
Practice Address - State:UT
Practice Address - Zip Code:84315-9639
Practice Address - Country:US
Practice Address - Phone:801-814-0570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8852593-3102163W00000X
UT8852593-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse