Provider Demographics
NPI:1285682112
Name:JARVIS, DONALD WILLIAM (LPN)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:WILLIAM
Last Name:JARVIS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BLDG. 5979 DESERT STORM AVE.
Mailing Address - Street 2:LAPOINTE HEALTH CLINIC
Mailing Address - City:FT. CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223
Mailing Address - Country:US
Mailing Address - Phone:270-956-0301
Mailing Address - Fax:
Practice Address - Street 1:BLDG. 5979 DESERT STORM AVE.
Practice Address - Street 2:LAPOINTE HEALTH CLINIC
Practice Address - City:FT. CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5349
Practice Address - Country:US
Practice Address - Phone:270-956-0301
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN50728164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse