Healthcare Provider Details

I. General information

NPI: 1114402013
Provider Name (Legal Business Name): HAYLEY MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ESPLANADE AVE STE 103
KENNER LA
70065-2473
US

IV. Provider business mailing address

331 22ND ST
NEW ORLEANS LA
70124
US

V. Phone/Fax

Practice location:
  • Phone: 504-464-8712
  • Fax:
Mailing address:
  • Phone: 504-810-8850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number203169
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: