Healthcare Provider Details

I. General information

NPI: 1659245306
Provider Name (Legal Business Name): HEALING HAVEN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7353 HIGHLAND RD
BATON ROUGE LA
70808-6641
US

IV. Provider business mailing address

59555 MYRTLE GROVE DR
PLAQUEMINE LA
70764-7438
US

V. Phone/Fax

Practice location:
  • Phone: 888-490-3319
  • Fax:
Mailing address:
  • Phone: 888-490-3318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY DAVIS
Title or Position: CREDENTIALING SPECIALISTS
Credential:
Phone: 912-373-4385