Haley Sue Back, MSN, APRN, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

4023046 Issued in KY

Practice address

601 Doe Run Dr
Suite 5
Mount Sterling, KY 40353-8880

Phone

(859) 432-3055

Fax

(859) 432-3044

NPI assigned

Jan 6, 2022

Reactivated

Jul 19, 2024

Last updated

Jul 19, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Haley Sue Moore Former name

Medicare fee-for-service enrollment

Enrolled in KY

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 1

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

May accept Medicare assignment

Group practices

Bluegrass Behavioral Health and Consulting ServicesGroup PAC ID 7719359280, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing

State licenses

Practice roles

Locations

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.

• Bluegrass Behavioral Health & Consulting Services

  • Psychiatric/Mental Health Nurse Practitioner
  • Mt Sterling, KY
  • NPI 1578234449
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1641427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721347200000",
    "number": "1982365557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 DOE RUN DR",
            "address_2": "SUITE 5",
            "city": "MOUNT STERLING",
            "state": "KY",
            "postal_code": "403538880",
            "telephone_number": "859-432-3055",
            "fax_number": "859-432-3044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 DOE RUN DR",
            "address_2": "SUITE 5",
            "city": "MOUNT STERLING",
            "state": "KY",
            "postal_code": "403538880",
            "telephone_number": "859-432-3055",
            "fax_number": "859-432-3044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACK",
        "first_name": "HALEY",
        "middle_name": "SUE",
        "name_prefix": "Ms.",
        "credential": "MSN, APRN, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-06",
        "last_updated": "2024-07-19",
        "certification_date": "2022-01-06",
        "deactivation_date": "2024-07-02",
        "reactivation_date": "2024-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "KY",
            "license": "4023046",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "KY",
            "license": "1167776",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HALEY",
            "last_name": "MOORE",
            "middle_name": "SUE",
            "credential": "BSN, RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amy Anderson
• Desiree Milne Antonson, M.S LPA
• Apothe-Care Inc. (Ross Drugs)
• Arrow Dental PLLC
• Leslie Aslam
• Brian Clifford Badger, M.D.
• Emilee Bailey-Offill, D.O.
• Courtney Bailey
• April Baker, OT
• Beverly Gayle Baker, DC

• Psychiatric/Mental Health Nurse Practitioner in Mt Sterling, KY
• Providers in Mt Sterling, KY by specialty
• Psychiatric/Mental Health Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.