Healthcare Provider Details

I. General information

NPI: 1376462804
Provider Name (Legal Business Name): HAILEY DENISE MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 SHED RD
BOSSIER CITY LA
71111-3670
US

IV. Provider business mailing address

197 SKYLER DR
GLOSTER LA
71030-3504
US

V. Phone/Fax

Practice location:
  • Phone: 318-746-3880
  • Fax:
Mailing address:
  • Phone: 318-453-1226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201154
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: