Provider Demographics
NPI:1265753057
Name:HOOTS, LAURA EILEEN (PA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:EILEEN
Last Name:HOOTS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7950 N SHADELAND AVE
Practice Address - Street 2:STE 350
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2699
Practice Address - Country:US
Practice Address - Phone:317-621-6900
Practice Address - Fax:317-621-4460
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01170033OtherRR MEDICARE PTAN
IN300005518Medicaid
IN300005518Medicaid