Provider Demographics
NPI:1912336488
Name:ANDERSON, LISA CHAVIS (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:CHAVIS
Last Name:ANDERSON
Suffix:
Gender:
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 STANFORD LEVY RD
Mailing Address - Street 2:
Mailing Address - City:DARROW
Mailing Address - State:LA
Mailing Address - Zip Code:70725-2137
Mailing Address - Country:US
Mailing Address - Phone:337-303-5910
Mailing Address - Fax:
Practice Address - Street 1:3116 STANFORD LEVY RD
Practice Address - Street 2:
Practice Address - City:DARROW
Practice Address - State:LA
Practice Address - Zip Code:70725-2137
Practice Address - Country:US
Practice Address - Phone:337-303-5910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO7584363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health