Individual
DR. HOLLY C PROVOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3975 I 49 S SERVICE RD, SUITE 205A, OPELOUSAS, LA 70570-0775
(337) 942-2323
(337) 942-2626
Mailing address
3975 I 49 S SERVICE RD, SUITE 205A, OPELOUSAS, LA 70570-0775
(337) 942-2323
(337) 942-2626
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
024378
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1571831
—
LA
01
—
160059334
RAILROAD MEDICARE PROV #
LA
01
—
7352418
AETNA PROVIDER ID NUMBER
AL
Enumeration date
07/13/2005
Last updated
07/09/2007
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