Provider Demographics
NPI:1033407713
Name:CHANEY, HOLLY WELLMAN TRAVIS (NP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:WELLMAN TRAVIS
Last Name:CHANEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 BLUEBONNET BLVD. STE 100
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810
Mailing Address - Country:US
Mailing Address - Phone:225-766-9091
Mailing Address - Fax:225-766-9317
Practice Address - Street 1:7777 BLUEBONNET BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1632
Practice Address - Country:US
Practice Address - Phone:225-766-9091
Practice Address - Fax:225-766-9317
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06560363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2157060Medicaid
LA3C560C822Medicare PIN