Healthcare Provider Details

I. General information

NPI: 1538168356
Provider Name (Legal Business Name): LAURA DAVIS HOLLIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA DAVIS

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 VETERANS BLVD SUITE B
DENHAM SPRINGS LA
70726-4722
US

IV. Provider business mailing address

311 VETERANS BLVD SUITE B
DENHAM SPRINGS LA
70726-4722
US

V. Phone/Fax

Practice location:
  • Phone: 225-665-4554
  • Fax: 225-655-6995
Mailing address:
  • Phone: 225-665-4554
  • Fax: 225-655-6995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN100808 AP04665
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: