Individual
JUDITH HAGGARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
500 RUSSELL ST, KENNETT, MO 63857-2102
(573) 717-1332
(573) 717-1335
Mailing address
PO BOX 400, NEW MADRID, MO 63869-0400
(573) 748-2404
(573) 748-2554
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
048374
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
424691103
—
MO
05
—
424691111
—
MO
Enumeration date
08/31/2006
Last updated
08/14/2014
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