Provider Demographics
NPI:1174783344
Name:DRAKE, LAURA LYNNE (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LYNNE
Last Name:DRAKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9775 HIGHWAY 190
Mailing Address - Street 2:SUITE F
Mailing Address - City:WALKER
Mailing Address - State:LA
Mailing Address - Zip Code:70785
Mailing Address - Country:US
Mailing Address - Phone:225-243-7716
Mailing Address - Fax:
Practice Address - Street 1:9775 HIGHWAY 190
Practice Address - Street 2:SUITE F
Practice Address - City:WALKER
Practice Address - State:LA
Practice Address - Zip Code:70785
Practice Address - Country:US
Practice Address - Phone:225-243-7716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.203842208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03774502Medicaid
LA1102768Medicaid
LA1102768Medicaid