| Jonell Hamilton Bolton, | |
|
5000 O'donovan Blvd, Suite 404, Walker, LA 70785-6351 | |
| (225) 271-6550 | |
| (225) 271-6551 |
| Full Name | Jonell Hamilton Bolton |
|---|---|
| Gender | Female |
| Speciality | Pediatrics |
| Location | 5000 O'donovan Blvd, Walker, Louisiana |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144529959 | NPI | - | NPPES |
| 2149890 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | 207163 (Louisiana) | Primary |
| Entity Name | Our Lady Of The Lake Physician Group Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1033494943 PECOS PAC ID: 4587849781 Enrollment ID: O20120529000377 |
| Mailing Address | Practice Location Address |
|---|---|
| Jonell Hamilton Bolton, 5000 O'donovan Blvd, Suite 404, Walker, LA 70785-6351 Ph: (225) 271-6550 | Jonell Hamilton Bolton, 5000 O'donovan Blvd, Suite 404, Walker, LA 70785-6351 Ph: (225) 271-6550 |
Dr. Laura Lynne Drake, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 9775 Highway 190, Suite F, Walker, LA 70785 Phone: 225-243-7716 | |
Tracy Alana Lemelle, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 5000 Odonavan Blvd, Walker, LA 70785 Phone: 225-369-8117 | |
Mrs. Leah Irene Houser, DENTAL ASSISTANT Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 14791 Springfield Rd., Walker, LA 70785 Phone: 541-736-6099 |