1023113784 NPI number — MRS. DEBRA JOYCE BAGGETT-WOODARD FNP-BC, PNP-BC

Table of content: MRS. DEBRA JOYCE BAGGETT-WOODARD FNP-BC, PNP-BC (NPI 1023113784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023113784 NPI number — MRS. DEBRA JOYCE BAGGETT-WOODARD FNP-BC, PNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAGGETT-WOODARD
Provider First Name:
DEBRA
Provider Middle Name:
JOYCE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC, PNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023113784
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1355 HARMON LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOMER
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71040-5815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-927-2306
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
926 FRANCES DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAYNESVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71038-6100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-624-0554
Provider Business Practice Location Address Fax Number:
318-624-3782
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN097166 AP03441 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 193808 . This is a "MEDICARE RHC" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1944327 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1433152 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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