Provider Demographics
NPI:1558004044
Name:HAGGARD, FUGUANA CAMELA CHINIKA
Entity Type:Individual
Prefix:
First Name:FUGUANA
Middle Name:CAMELA CHINIKA
Last Name:HAGGARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FUGUANA
Other - Middle Name:
Other - Last Name:MIDDLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2007 WHISPERING MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-2999
Mailing Address - Country:US
Mailing Address - Phone:908-809-9233
Mailing Address - Fax:
Practice Address - Street 1:24634 RUSTLER LN
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MO
Practice Address - Zip Code:65556-7200
Practice Address - Country:US
Practice Address - Phone:908-809-9233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator