Provider Demographics
NPI:1275943086
Name:HAUGH, DESIREE BROOKE (NP-C)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:BROOKE
Last Name:HAUGH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 RIDGEMONT VILLA
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-1010
Mailing Address - Country:US
Mailing Address - Phone:662-368-3858
Mailing Address - Fax:662-368-3931
Practice Address - Street 1:103 RIDGEMONT VILLA
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-1010
Practice Address - Country:US
Practice Address - Phone:662-368-3858
Practice Address - Fax:662-368-3931
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-01
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR881909363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily