Provider Demographics
NPI:1043742471
Name:HAZZLERIGG, KHAKI RENEE (FNP-C)
Entity type:Individual
Prefix:
First Name:KHAKI
Middle Name:RENEE
Last Name:HAZZLERIGG
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 1:16725 LENA LN
Mailing Address - Street 2:
Mailing Address - City:FRENCH SETTLEMENT
Mailing Address - State:LA
Mailing Address - Zip Code:70733-2205
Mailing Address - Country:US
Mailing Address - Phone:225-603-5287
Mailing Address - Fax:
Practice Address - Street 1:100 WOMANS WAY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-5100
Practice Address - Country:US
Practice Address - Phone:225-927-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09145363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily