Healthcare Provider Details

I. General information

NPI: 1033407713
Provider Name (Legal Business Name): HOLLY WELLMAN TRAVIS CHANEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 BLUEBONNET BLVD STE 100
BATON ROUGE LA
70810-1632
US

IV. Provider business mailing address

7777 BLUEBONNET BLVD. STE 100
BATON ROUGE LA
70810
US

V. Phone/Fax

Practice location:
  • Phone: 225-766-9091
  • Fax: 225-766-9317
Mailing address:
  • Phone: 225-766-9091
  • Fax: 225-766-9317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP06560
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP06560
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: