Provider Demographics
NPI:1518930072
Name:ENTREKIN, LAURA (NP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:ENTREKIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:RENEE
Other - Last Name:FLEMING SAVAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3370
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70434-3370
Mailing Address - Country:US
Mailing Address - Phone:985-400-5988
Mailing Address - Fax:985-256-5687
Practice Address - Street 1:1970 N HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5364
Practice Address - Country:US
Practice Address - Phone:985-400-5988
Practice Address - Fax:985-256-5687
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN081665 APO4322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1192007Medicaid
LA1192007Medicaid
LAP00241826OtherRAIL ROAD MEDICARE
MS07151317Medicaid
LAP00241826OtherRAIL ROAD MEDICARE
LA1192007Medicaid