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General NPI Number Information
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NPI Number | 1730466053
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Entity Type | Individual
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Provider Name | MICHELLE MOORE HAYNIE NNP
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Gender | Female
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Dates
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Enumeration Date | 11/15/2011
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 1453 E.BERT KOUNS INDUSTRIAL LOOP, NICU WEST WING
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City | SHREVEPORT
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State | LA
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Zip | 71105
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Country | US
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Telephone | 318-681-4316
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Fax |
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Provider Business Mailing Address
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Address Line | 333 JOHNS BLUFF CIR
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City | SHREVEPORT
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State | LA
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Zip | 71106-4733
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Country | US
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Telephone | 318-426-5556
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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 | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | AP06220
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP06220
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | AP130435
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | PA040129
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License Number State | LA
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