Provider Demographics
NPI:1982368049
Name:STUBBLEFIELD, HAIYDEN FAITH
Entity type:Individual
Prefix:
First Name:HAIYDEN
Middle Name:FAITH
Last Name:STUBBLEFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HAIYDEN
Other - Middle Name:FAITH
Other - Last Name:DOBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1156 COUNTY ROAD 523
Mailing Address - Street 2:
Mailing Address - City:FYFFE
Mailing Address - State:AL
Mailing Address - Zip Code:35971-4339
Mailing Address - Country:US
Mailing Address - Phone:256-601-7921
Mailing Address - Fax:
Practice Address - Street 1:212 AIRPORT RD W
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3335
Practice Address - Country:US
Practice Address - Phone:256-979-1250
Practice Address - Fax:256-979-1251
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-169815163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered Nurse