Provider Demographics
NPI:1073624078
Name:ROY, ROBERT HOLLAND (NP)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:HOLLAND
Last Name:ROY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2374
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71294-2374
Mailing Address - Country:US
Mailing Address - Phone:318-396-3800
Mailing Address - Fax:318-396-3852
Practice Address - Street 1:730 CELEBRITY DRIVE
Practice Address - Street 2:AMERICAN STAT CARE CENTER
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270
Practice Address - Country:US
Practice Address - Phone:318-255-2100
Practice Address - Fax:318-255-2040
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03161363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1546241Medicaid
LA1546241Medicaid
LA5X615Medicare ID - Type Unspecified