Individual
HAILEY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
916 KENTUCKY AVE, PADUCAH, KY 42003-1977
(270) 444-9631
(270) 442-8769
Mailing address
916 KENTUCKY AVE, PADUCAH, KY 42003-1977
(270) 444-9631
(270) 442-8769
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
4007951
KY
363LC1500X
Community Health Nurse Practitioner
Primary
4007951
KY
Other
Enumeration date
07/28/2025
Last updated
07/28/2025
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