Provider Demographics
NPI:1225559917
Name:HAYGOOD, RONESHA (ADMINISTRATOR/ OWNER)
Entity Type:Individual
Prefix:
First Name:RONESHA
Middle Name:
Last Name:HAYGOOD
Suffix:
Gender:F
Credentials:ADMINISTRATOR/ OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 RAYMOND RD APT 17K
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-4296
Mailing Address - Country:US
Mailing Address - Phone:601-282-3132
Mailing Address - Fax:
Practice Address - Street 1:1636 RAYMOND ROAD APT 17K
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39205
Practice Address - Country:US
Practice Address - Phone:662-394-5959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker