Provider Demographics
NPI:1194346916
Name:PARHAM, LAVONNA (NNP)
Entity type:Individual
Prefix:
First Name:LAVONNA
Middle Name:
Last Name:PARHAM
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 DICKORY AVE APT G370
Mailing Address - Street 2:
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123-2297
Mailing Address - Country:US
Mailing Address - Phone:205-249-4442
Mailing Address - Fax:
Practice Address - Street 1:500 RUE DE LA VIE ST STE 405
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-5128
Practice Address - Country:US
Practice Address - Phone:225-928-2555
Practice Address - Fax:225-929-9685
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA212646363LN0000X, 363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal