Haley Bolen, CRNP
Individual provider Active NPI Family Nurse Practitioner · Northport, AL
NPI 1104416486 · NPPES record last updated Jan 21, 2021
Key facts
- NPI
- 1104416486
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 1-145272 (AL)
- Practice address
- 1116 Mitt Lary Rd
Northport, AL 35475-4978 - Phone
- (205) 556-5634
- NPI assigned
- Jan 21, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210511001253 | AL | Practitioner - Nurse Practitioner | 3870909542 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-145272 | AL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Relias Emergency Medicine Specialists of Regional, LLC | Current |
Accepting new patients | |
| Relias Emergency Medicine Specialists of Northport, LLC | Current |
Accepting new patients |
Locations
2700 Hospital Dr
Northport, AL 35476
Phone (205) 333-4500
809 University Blvd E
Tuscaloosa, AL 35401
Phone (205) 333-4661
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 1-145272 | AL | Yes |
Addresses
Primary practice location
1116 Mitt Lary Rd
Northport, AL 35475-4978
Mailing address
1116 Mitt Lary Rd
Northport, AL 35475-4978
Phone (205) 556-5634
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | Northport |
Other providers in Northport, AL
- Justin Ray Bevel
- Raven Billups
- Black Warrior Behavioral Health LLC
- Rain Henry Blankenship
- Jessica Lynn Bogucki
- Kelly M Bonnett
- Bony F Barrineau MD PC
- Andrew Cody Bounds
- Andrea G Bowden-Evans
- Jeni Bowen
All providers in Northport, AL · Family Nurse Practitioner in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.