Provider Demographics
NPI:1992329973
Name:RAVASSIPOUR, ALLISON NEWTON (FNP-C)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:NEWTON
Last Name:RAVASSIPOUR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 WOODTHRUSH DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-4004
Mailing Address - Country:US
Mailing Address - Phone:817-597-9036
Mailing Address - Fax:
Practice Address - Street 1:110 WOODTHRUSH DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-4004
Practice Address - Country:US
Practice Address - Phone:817-597-9036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000172363LF0000X
LA213636363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily