Undra L Haggan, NURSE PRACTITIONER

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

903148 Issued in MS

Practice address

1202 Desoto Ave
Clarksdale, MS 38614-6937

Phone

(662) 202-1297

NPI assigned

Feb 8, 2019

Last updated

Jun 7, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aaron E Henry Community HealthGroup PAC ID 1153230560, 13 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northwest Missississippi Regional Medical Center Hospital, Clarksdale, MS, CCN 250042

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: undra.haggan@aehchc.eclinicaldirectplus.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Aaron E Henry Community Health

  • Federally Qualified Health Center (FQHC)
  • Batesville, MS
  • NPI 1003814104
  Medicare reassignment Care Compare group NPD
• Fast Pace Mississippi, PLLC

  • Rural Health Clinic/Center
  • Ripley, MS
  • NPI 1447769559
  Medicare reassignment NPD
• Aaron E. Henry Community Health Services Center, Inc

  • Pediatrics Physician
  • Clarksdale, MS
  • NPI 1134868672
  NPD
• Fast Pace Mississippi, PLLC

  • Rural Health Clinic/Center
  • Kosciusko, MS
  • NPI 1851050579
  NPD
• Aaron E Henry Community Health

  dba Aaron E Henry Mobile Medical Unit #3

  • Federally Qualified Health Center (FQHC)
  • Clarksdale, MS
  • NPI 1063756716
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Northwest Miss Regional Medical Center

  dba Northwest Mississippi Regional Medical Center

  • General Acute Care Hospital
  • Clarksdale, MS
  • NPI 1275217606
  Care Compare affiliation

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

{
    "created_epoch": "1549584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559865600000",
    "number": "1144785684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "619 S STATE ST",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386146319",
            "telephone_number": "662-645-4827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 DESOTO AVE",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386146937",
            "telephone_number": "662-202-1297"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1202 DeSoto Ave",
            "address_purpose": "LOCATION",
            "city": "Clarksdale",
            "state": "MS",
            "postal_code": "386146937",
            "country_code": "US",
            "telephone_number": "662-202-1297",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAGGAN",
        "first_name": "UNDRA",
        "middle_name": "L",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-08",
        "last_updated": "2019-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MS",
            "license": "903148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Regina Denise Groner, NURSE PRACTITIONER
• Guardian Angel Adult Day Services LLC
• Meghann E Gulledge Yee, M.ED.
• Cody Renaldo Gullick, FNP-C
• Mohamad F Hadidi, M.D.
• Haggard Drug Store Inc.
• Clifford Hall, M.D.
• Alvin Ray Hamilton Jr., CRNA
• Lakedra T Hampton, MSW
• Africa Joanalene Harris-Johnson, DPT

• Primary Care Nurse Practitioner in Clarksdale, MS
• Providers in Clarksdale, MS by specialty
• Primary Care Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.