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NPI Code Detail

MEDICARE: HOLLY L EDMONDS PA-C

MEDICARE: HOLLY L EDMONDS PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician AssistantA10599LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
16347958OTHERLALOUISIANA LICENSE

General Provider Information

NPI Number : 1669611034
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY L EDMONDS PA-C
Provider Business Mailing Address
First Line : 5959 S SHERWOOD FOREST BLVD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70816-6038
Country : US
Telephone Number : 225-765-5727
Fax Number : 225-765-9196
Provider Business Practice Location Address
First Line : 6400 PERKINS RD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70808-4124
Country : US
Telephone Number : 225-330-0497
Fax Number : 225-330-0498
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2009
Last Update Date : 01/28/2022

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Directions to “ HOLLY L EDMONDS PA-C” Practice Location

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