Basic Information
Provider Information | |||||||||
NPI: | 1962639104 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WALTERS HAYGOOD | ||||||||
FirstName: | CHRISTEN | ||||||||
MiddleName: | LYNEL | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | WALTERS | ||||||||
OtherFirstName: | CHRISTEN | ||||||||
OtherMiddleName: | LYNEL | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 23666 | ||||||||
Address2: |   | ||||||||
City: | JACKSON | ||||||||
State: | MS | ||||||||
PostalCode: | 392253666 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6012004749 | ||||||||
FaxNumber: | 6012005929 | ||||||||
Practice Location | |||||||||
Address1: | 971 LAKELAND DR | ||||||||
Address2: | SUITE 750 | ||||||||
City: | JACKSON | ||||||||
State: | MS | ||||||||
PostalCode: | 392164643 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6012005955 | ||||||||
FaxNumber: | 6012005943 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/15/2009 | ||||||||
LastUpdateDate: | 06/28/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0201X | 24411 | MS | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
No ID Information.