Healthcare Provider Details

I. General information

NPI: 1134636293
Provider Name (Legal Business Name): HOLLY REICHARDT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 JULIA ST
RAYVILLE LA
71269-2608
US

IV. Provider business mailing address

832 JULIA ST
RAYVILLE LA
71269-2608
US

V. Phone/Fax

Practice location:
  • Phone: 318-728-4787
  • Fax: 318-728-2598
Mailing address:
  • Phone: 318-728-4787
  • Fax: 318-728-2598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP09724
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: