=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205343803
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TONETTE HARRIS-HAYNES PMHNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2018
-----------------------------------------------------
Last Update Date | 08/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 230 ROBERTS DR STE H
-----------------------------------------------------
City | NEW ROADS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70760-2661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-618-7800
-----------------------------------------------------
Fax | 225-238-8330
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8
-----------------------------------------------------
City | SICILY ISLAND
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71368-0008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-389-5727
-----------------------------------------------------
Fax | 318-389-9943
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | AP04677
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------