Provider Demographics
NPI:1174120307
Name:HOCKENJOS, OLIVIA (PA)
Entity type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:
Last Name:HOCKENJOS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 HEALTHCARE PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-1700
Mailing Address - Country:US
Mailing Address - Phone:318-706-0022
Mailing Address - Fax:318-706-0023
Practice Address - Street 1:170 HEALTHCARE PLAZA DR
Practice Address - Street 2:
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037-1700
Practice Address - Country:US
Practice Address - Phone:318-706-0022
Practice Address - Fax:318-706-0023
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA324557363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant