Healthcare Provider Details

I. General information

NPI: 1902042765
Provider Name (Legal Business Name): CAYLON W. HAGGARD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 S ADAMS ST
RITZVILLE WA
99169-2227
US

IV. Provider business mailing address

411 FORTUYN RD
GRAND COULEE WA
99133-8718
US

V. Phone/Fax

Practice location:
  • Phone: 96-591-2005
  • Fax: 509-659-0632
Mailing address:
  • Phone: 509-633-1911
  • Fax: 509-633-1933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61041209
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: