Individual
DEBORAH SUSAN HOLLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1455 E BERT KOUNS LOOP, SHREVEPORT, LA 71105-5634
(318) 798-4623
(318) 798-4591
Mailing address
1455 E BERT KOUNS LOOP, SHREVEPORT, LA 71105-5634
(318) 798-4623
(318) 798-4591
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA.A10355.RX
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1625221
—
LA
01
—
P00090026
RAILROAD MEDICARE NUMBER
LA
Enumeration date
08/25/2005
Last updated
03/12/2013
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