Provider Demographics
NPI:1346801461
Name:BILLINGSLEY, LAUREN JACOB (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:JACOB
Last Name:BILLINGSLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAREN
Other - Middle Name:BROOKE
Other - Last Name:JACOB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-765-5500
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:1023 W HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5002
Practice Address - Country:US
Practice Address - Phone:225-765-5500
Practice Address - Fax:225-647-5342
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA320036363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant