MEDICARE: HEALING HAVEN PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
2	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1659245306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING HAVEN PLLC

Provider Business Mailing Address
First Line	:	59555 MYRTLE GROVE DR
Second Line	:
City	:	PLAQUEMINE
State	:	LA
Zip	:	70764-7438
Country	:	US
Telephone Number	:	888-490-3318
Fax Number	:

Provider Business Practice Location Address
First Line	:	7353 HIGHLAND RD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-6641
Country	:	US
Telephone Number	:	888-490-3319
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALISTS
Name	:	KIMBERLY DAVIS
Credential	:
Telephone Number	:	912-373-4385

Provider Enumeration Date	:	10/03/2025
Last Update Date	:	10/03/2025

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Directions to “HEALING HAVEN PLLC ” Practice Location

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