Provider Demographics
NPI:1023113784
Name:BAGGETT-WOODARD, DEBRA JOYCE (FNP-BC, PNP-BC)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:JOYCE
Last Name:BAGGETT-WOODARD
Suffix:
Gender:F
Credentials:FNP-BC, PNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 HARMON LOOP
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:LA
Mailing Address - Zip Code:71040-5815
Mailing Address - Country:US
Mailing Address - Phone:318-927-2306
Mailing Address - Fax:
Practice Address - Street 1:926 FRANCES DR
Practice Address - Street 2:
Practice Address - City:HAYNESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71038-6100
Practice Address - Country:US
Practice Address - Phone:318-624-0554
Practice Address - Fax:318-624-3782
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN097166 AP03441363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA193808OtherMEDICARE RHC
LA1944327Medicaid
LA1433152Medicaid
LA1433152Medicaid