Provider Demographics
NPI:1538168356
Name:HOLLIS, LAURA DAVIS (NP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:DAVIS
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:311 VETERANS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-4722
Mailing Address - Country:US
Mailing Address - Phone:225-665-4554
Mailing Address - Fax:225-655-6995
Practice Address - Street 1:311 VETERANS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4722
Practice Address - Country:US
Practice Address - Phone:225-665-4554
Practice Address - Fax:225-655-6995
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN100808 AP04665363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1620891Medicaid
LA4H931D279Medicare PIN
LAQ71844Medicare UPIN
LA1620891Medicaid