Healthcare Provider Details

I. General information

NPI: 1962840850
Provider Name (Legal Business Name): KAREN LEIGH HAYNIE D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 06/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 BERT KOUNS INDUSTRIAL LOOP SUITE 700
SHREVEPORT LA
71106-8158
US

IV. Provider business mailing address

7217 GILBERT DR
SHREVEPORT LA
71106-4730
US

V. Phone/Fax

Practice location:
  • Phone: 318-688-9330
  • Fax:
Mailing address:
  • Phone: 318-469-6046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6381
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: