Healthcare Provider Details

I. General information

NPI: 1346505393
Provider Name (Legal Business Name): HEATHER HOLLIS DAVIS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 HIGHLAND AVE
BASTROP LA
71220-2241
US

IV. Provider business mailing address

PO BOX 792
BASTROP LA
71221-0792
US

V. Phone/Fax

Practice location:
  • Phone: 318-239-3883
  • Fax: 318-239-3857
Mailing address:
  • Phone: 318-283-8887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPO6910
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: