Individual
MS. HALEY MARIE MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
296 STAFFORD LN, DELTA, CO 81416-2273
(970) 874-5777
(970) 874-1631
Mailing address
PO BOX 10100, DELTA, CO 81416-0008
(970) 874-5777
(970) 874-1631
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA.0006117
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000250847
—
CO
Enumeration date
02/06/2019
Last updated
06/05/2026
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