Provider Demographics
NPI:1871508655
Name:HAGGARD, LINDA M (PAC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:HAGGARD
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:D
Other - Last Name:METZLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1146 WEST SOUTH ROUTE 89A
Mailing Address - Street 2:SUITE B1
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5768
Mailing Address - Country:US
Mailing Address - Phone:928-284-0166
Mailing Address - Fax:928-284-1810
Practice Address - Street 1:450 S WILLARD ST STE 101
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-6744
Practice Address - Country:US
Practice Address - Phone:928-284-0166
Practice Address - Fax:928-284-1810
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3341363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ361588Medicaid