Provider Demographics
NPI:1194211094
Name:HAZZARD ANDREWS, CARLY MARANNE (NP)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:MARANNE
Last Name:HAZZARD ANDREWS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N PEARMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-3502
Mailing Address - Country:US
Mailing Address - Phone:888-757-0838
Mailing Address - Fax:662-579-3378
Practice Address - Street 1:800 N PEARMAN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-3502
Practice Address - Country:US
Practice Address - Phone:888-757-0838
Practice Address - Fax:662-579-3378
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902784363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner