Individual provider Active NPI

Theresa Anne Haley, FNP-C

  • Family Nurse Practitioner
  • Prescott, AZ
National Provider Identifier
1609398650
Registry record updated Jul 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
218433 Issued in AZ
Practice address
500 N State Route 89 RM 203
Prescott, AZ 86313-5001
Phone
(928) 717-7456
NPI assigned
Jul 12, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 218433 AZ Primary

Addresses

Primary practice location

500 N State Route 89 RM 203
Prescott, AZ 86313-5001

Mailing address

500 N State Route 89 RM 203
Prescott, AZ 86313-5001
Phone (928) 717-7456

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190717001379 AZ Practitioner - Nurse Practitioner 0749553766 Reassigns benefits to 2 organizations
I20190906000183 TX Practitioner - Nurse Practitioner 0749553766 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
218433AZMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm CurrentSince May 26, 2019 Accepting new patients
Cep America-Arizona, PC CurrentSince Nov 2, 2020 Accepting new patients
Cep America- Arizona, PC Current Accepting new patients
Alliance Urgent Care PLLC CurrentSince Aug 1, 2020 Accepting new patients
Cep America - Arizona PC CurrentSince Nov 2, 2020 Accepting new patients
Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm CurrentSince May 26, 2019 Accepting new patients
Arizona Heart Specialists PLLC Past Accepting new patients

Locations

1405 S Alma School Rd
Chandler, AZ 85286
Phone (480) 256-7000

1400 S Dobson Rd
Mesa, AZ 85202
Phone (480) 412-3000

4212 N 16th St
Phoenix, AZ 85016
Phone (602) 248-4187

10401 W Thunderbird Blvd
Sun City, AZ 85351
Phone (623) 815-7690

9897 W McDowell Rd
Ste 100
Tolleson, AZ 85353
Phone (623) 474-2300

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

Organizations & group practices 7

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": "1499817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784073600000",
    "number": "1609398650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 N STATE ROUTE 89 RM 203",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863135001",
            "telephone_number": "928-717-7456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N STATE ROUTE 89 RM 203",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863135001",
            "telephone_number": "928-717-7456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALEY",
        "first_name": "THERESA",
        "middle_name": "ANNE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-12",
        "last_updated": "2026-07-15",
        "certification_date": "2026-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "218433",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott, AZ

Sources for this page

Verify at the official NPI Registry.