Provider Demographics
NPI:1326043753
Name:BABERS-WILSON, LAVORA (APRN-NP)
Entity Type:Individual
Prefix:
First Name:LAVORA
Middle Name:
Last Name:BABERS-WILSON
Suffix:
Gender:F
Credentials:APRN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 KEYSER AVE
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-5801
Mailing Address - Country:US
Mailing Address - Phone:318-356-5566
Mailing Address - Fax:318-356-5596
Practice Address - Street 1:1635 MARVEL ST
Practice Address - Street 2:
Practice Address - City:COUSHATTA
Practice Address - State:LA
Practice Address - Zip Code:71019
Practice Address - Country:US
Practice Address - Phone:318-932-2081
Practice Address - Fax:318-932-2215
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN082641AP04551363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1621293Medicaid
LAQ52287Medicare UPIN