Healthcare Provider Details

I. General information

NPI: 1609893635
Provider Name (Legal Business Name): JANNA NIXON HAAS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 S TYLER ST
COVINGTON LA
70433-2330
US

IV. Provider business mailing address

71398 S RIVER DR
COVINGTON LA
70433-8843
US

V. Phone/Fax

Practice location:
  • Phone: 985-898-4438
  • Fax:
Mailing address:
  • Phone: 985-630-7191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN032238
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: