Haley Catherine Johnson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-10199 Issued in NC

Practice address

903 Northeast Dr Ste 301
Davidson, NC 28036-7438

Phone

(704) 894-9309

NPI assigned

Jan 11, 2019

Reactivated

Jun 2, 2020

Last updated

Oct 5, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Southlake Psychiatry PC

  • Psychiatry Physician
  • Davidson, NC
  • NPI 1295921724

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1547164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791158400000",
    "number": "1841763968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 823",
            "city": "DAVIDSON",
            "state": "NC",
            "postal_code": "280360823",
            "telephone_number": "704-894-9309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 NORTHEAST DR STE 301",
            "city": "DAVIDSON",
            "state": "NC",
            "postal_code": "280367438",
            "telephone_number": "704-894-9309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "HALEY",
        "middle_name": "CATHERINE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-11",
        "last_updated": "2026-10-05",
        "certification_date": "2026-10-05",
        "deactivation_date": "2019-01-11",
        "reactivation_date": "2020-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-10199",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC MEDICAL LICENSE",
            "identifier": "0010-10199",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Candace Rowe Jackson, PTA
• Aime A. Janawsky
• Jeannine Bodner, LCSW, PLLC
• Crystal Janelle Johnson, MD
• Emily Setliff Johnson, PA
• Renee Shull Johnson, MA, NCC, LPC
• Jennifer Johnston, MA, LCMHC-A, NCC
• Melissa Jones, COTA/L
• Kayla Kaesmeyer
• Sarah Jennifer Kane, MSW, LCSW

• Physician Assistant in Davidson, NC
• Providers in Davidson, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2026; 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.