Provider Demographics
NPI:1821661430
Name:HAGGART, MANDIE MICHELLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:MANDIE
Middle Name:MICHELLE
Last Name:HAGGART
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 LOYD BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHENEYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71325-9140
Mailing Address - Country:US
Mailing Address - Phone:318-308-3443
Mailing Address - Fax:
Practice Address - Street 1:2810 US HWY 71 S
Practice Address - Street 2:
Practice Address - City:LECOMPTE
Practice Address - State:LA
Practice Address - Zip Code:71346-0000
Practice Address - Country:US
Practice Address - Phone:318-290-3900
Practice Address - Fax:318-373-3400
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA220708363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine