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NPI Code Detail

MEDICARE: KELLYE HAZELWOOD

MEDICARE: KELLYE HAZELWOOD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1225995640
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLYE HAZELWOOD
Provider Business Mailing Address
First Line : 1000 CHINABERRY DR STE 900
Second Line :
City : BOSSIER CITY
State : LA
Zip : 71111-2455
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 525 ALEXANDER ST
Second Line :
City : JONESBORO
State : LA
Zip : 71251-2001
Country : US
Telephone Number : 318-259-4676
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2026
Last Update Date : 01/07/2026

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Directions to “ KELLYE HAZELWOOD ” Practice Location

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