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General NPI Number Information
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NPI Number | 1699315622
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Entity Type | Individual
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Provider Name | MICKI L. HAYDEN AGACNP
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Gender | Female
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Dates
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Enumeration Date | 01/07/2020
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Last Update Date | 01/07/2020
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Provider Practice Location Address
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Address Line | 4055 VALLEY VIEW LN
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City | DALLAS
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State | TX
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Zip | 75244-5074
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Country | US
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Telephone | 877-868-5351
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Fax |
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Provider Business Mailing Address
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Address Line | 152 SILVERWOOD DR
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City | SLIDELL
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State | LA
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Zip | 70461-4110
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Country | US
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Telephone | 214-796-1953
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 205030
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License Number State | LA
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