=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659245306
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALING HAVEN PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2025
-----------------------------------------------------
Last Update Date | 10/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7353 HIGHLAND RD
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70808-6641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-490-3319
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 59555 MYRTLE GROVE DR
-----------------------------------------------------
City | PLAQUEMINE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70764-7438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-490-3318
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING SPECIALISTS
-----------------------------------------------------
Name | KIMBERLY DAVIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 912-373-4385
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------