Individual provider Active NPI

Haley Ann Shirley, NP

  • Pediatric Nurse Practitioner
  • Lebanon, IN
National Provider Identifier
1154962793
Registry record updated Oct 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
71010224A Issued in IN
Practice address
2705 N Lebanon St Ste 415
Lebanon, IN 46052-8621
Phone
(765) 485-8900
Fax
(765) 485-8909
NPI assigned
Oct 4, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Lactation Consultant (Registered Nurse) 163WL0100X 28200649A IN
Pediatric Nurse Practitioner 363LP0200X 71010224A IN Primary

Addresses

Primary practice location

2705 N Lebanon St Ste 415
Lebanon, IN 46052-8621

Mailing address

2605 N Lebanon St
Lebanon, IN 46052-1476

Other identifiers 1

IdentifierTypeStateIssuer
300040941MedicaidIN

Other names 1

  • Haley Ann Hendrix Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address hshirley@withamdirect.org Health Information Exchange (HIE) Witham Memorial Hospital

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
28200649AINMDLactation Consultant (Registered Nurse)
71010224AINMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Witham Memorial Hospital PastSince Aug 2, 2020 Accepting new patients
Witham Memorial Hospital PastSince Aug 2, 2020 Accepting new patients
Windber Hospital, Inc. Past Accepting new patients
Indy Lactation Care,LLC Lactation Consultant Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: hshirley@withamdirect.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1570147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696982400000",
    "number": "1154962793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2605 N LEBANON ST",
            "city": "LEBANON",
            "state": "IN",
            "postal_code": "460521476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2705 N LEBANON ST STE 415",
            "city": "LEBANON",
            "state": "IN",
            "postal_code": "460528621",
            "telephone_number": "765-485-8900",
            "fax_number": "765-485-8909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIRLEY",
        "first_name": "HALEY",
        "middle_name": "ANN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-04",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "IN",
            "license": "28200649A",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IN",
            "license": "71010224A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300040941",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hshirley@withamdirect.org",
            "affiliation": "Y",
            "affiliationName": "Witham Memorial Hospital",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "2705 N Lebanon St Ste 415",
            "city": "Lebanon",
            "state": "IN",
            "country_code": "US",
            "postal_code": "460528621",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "HALEY",
            "last_name": "HENDRIX",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lebanon, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.