Provider Demographics
NPI:1750394904
Name:HAYGOOD-KANE, TIAJUANA LYNNE (DO)
Entity type:Individual
Prefix:DR
First Name:TIAJUANA
Middle Name:LYNNE
Last Name:HAYGOOD-KANE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LYNNE
Other - Middle Name:HAYGOOD
Other - Last Name:HALLSTROM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNM
Mailing Address - Street 1:1541 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4228
Mailing Address - Country:US
Mailing Address - Phone:318-626-0287
Mailing Address - Fax:
Practice Address - Street 1:1541 KINGS HWY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4228
Practice Address - Country:US
Practice Address - Phone:318-626-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN263485 NM02968367A00000X
LA335575207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
S24216Medicare UPIN
KY78009206Medicaid
OHHANM00407Medicare ID - Type Unspecified
LA1174734Medicaid
S24216Medicare UPIN