Provider Demographics
NPI:1235895954
Name:CLEVENGER, LAVY (NP)
Entity Type:Individual
Prefix:
First Name:LAVY
Middle Name:
Last Name:CLEVENGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAVY
Other - Middle Name:
Other - Last Name:HENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 277723
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-7723
Mailing Address - Country:US
Mailing Address - Phone:864-560-4123
Mailing Address - Fax:864-560-4023
Practice Address - Street 1:101 E WOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-6000
Practice Address - Fax:864-560-4023
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25572363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSCN267O696OtherMEDICARE PIN
SCSCN2679225OtherMEDICARE PIN
SCNP8658Medicaid
SCSCN2673365OtherMEDICARE PIN