Hazel Street Nursing Association

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

725 Issued in AR

Legal business name

HAZEL STREET NURSING ASSOCIATION

Practice address

6811 S Hazel St
Pine Bluff, AR 71603-7829

Phone

(870) 535-1155

Fax

(870) 535-0732

NPI assigned

Oct 11, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael T Shepard

Title

Executive Director

Phone

(870) 541-0342

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Davis East Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373587200000",
    "number": "1104814383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6811 S HAZEL ST",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716037829",
            "telephone_number": "870-535-1155",
            "fax_number": "870-535-0732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6811 S HAZEL ST",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716037829",
            "telephone_number": "870-535-1155",
            "fax_number": "870-535-0732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAZEL STREET NURSING ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-11",
        "last_updated": "2013-07-12",
        "status": "A",
        "authorized_official_last_name": "SHEPARD",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "870-541-0342"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AR",
            "license": "725",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119733311",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Davis East",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elizabeth Hartz, DNP, APRN, FNP-BC
• Khaled Hassan, MD
• Kai Charmeen Hawkins
• Rae-Shem Hawkins, B.S
• Jackson Haynes, MD
• Annabeth Monet Hazlewood, APN
• Healing Circle Relationship Wellness Center LLC
• Healthwise Wellness Direct PLLC
• Healthwise Wellness LLC
• Heather N. Leblanc, M.D., PA

• Skilled Nursing Facility in Pine Bluff, AR
• Providers in Pine Bluff, AR by specialty
• Skilled Nursing Facility in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.