Provider Demographics
NPI:1265326870
Name:MAGNOLIA HEALTHCARE PROVIDERS
Entity type:Organization
Organization Name:MAGNOLIA HEALTHCARE PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SHANI
Authorized Official - Middle Name:GORIO
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:985-507-8346
Mailing Address - Street 1:1752 OX BOW LN
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7273
Mailing Address - Country:US
Mailing Address - Phone:985-507-8436
Mailing Address - Fax:985-781-4319
Practice Address - Street 1:201 GREENBRIER BLVD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7236
Practice Address - Country:US
Practice Address - Phone:985-224-4135
Practice Address - Fax:985-781-4319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty