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General NPI Number Information
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NPI Number | 1134469463
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Entity Type | Individual
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Provider Name | HOLLY GAINES SCURLOCK PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/23/2013
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Last Update Date | 02/23/2013
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Provider Practice Location Address
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Address Line | 9300 MANSFIELD RD
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City | SHREVEPORT
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State | LA
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Zip | 71118-3155
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Country | US
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Telephone | 318-629-3763
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Fax | 318-629-3767
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Provider Business Mailing Address
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Address Line | 9300 MANSFIELD RD
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City | SHREVEPORT
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State | LA
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Zip | 71118-3155
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Country | US
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Telephone | 318-629-3763
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Fax | 318-629-3767
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA.200600
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License Number State | LA
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