Provider Demographics
NPI:1295928794
Name:BLOUNT, LAURA CHAVERS (FNP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:CHAVERS
Last Name:BLOUNT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:CHAVERS
Other - Last Name:BLOUNT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1000 J.W. DAVIS DRIVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403
Mailing Address - Country:US
Mailing Address - Phone:985-350-6505
Mailing Address - Fax:985-350-6509
Practice Address - Street 1:1000 J.W. DAVIS DRIVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403
Practice Address - Country:US
Practice Address - Phone:985-350-6505
Practice Address - Fax:985-350-6509
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN097188363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LADO6873OtherMEDICARE RAILROAD GROUP PTAN
LAP00780481OtherMEDICARE RAILROAD PTAN
LA1027774Medicaid
LA3A525Medicare PIN