Provider Demographics
NPI:1477534972
Name:HOLLISTER-MEADOWS, LAURA (FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:HOLLISTER-MEADOWS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:HOLLISTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:275 PIPER ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-8703
Mailing Address - Country:US
Mailing Address - Phone:360-801-3430
Mailing Address - Fax:
Practice Address - Street 1:8503 W CLEARWATER AVE STE B
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3100
Practice Address - Country:US
Practice Address - Phone:509-303-3428
Practice Address - Fax:509-579-0062
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007335363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9649039Medicaid
WA8861064OtherMEDICARE RHC
Q71384Medicare UPIN
WAG8861064Medicare Oscar/Certification