MEDICARE: HALEY BENNETT BRANCH

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	363LF0000X	Family Nurse Practitioner	202317	LA

General Provider Information

NPI Number	:	1831950401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY BENNETT BRANCH

Provider Business Mailing Address
First Line	:	402 MCMILLAN RD
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-5326
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 MCMILLAN RD
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-5326
Country	:	US
Telephone Number	:	318-338-3540
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2024
Last Update Date	:	01/19/2024

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Directions to “ HALEY BENNETT BRANCH ” Practice Location

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