Provider Demographics
NPI:1326408576
Name:HENDERSON, ADRAVON S (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ADRAVON
Middle Name:S
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:ADRAVON
Other - Middle Name:S
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:8110 SUMMA AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3419
Mailing Address - Country:US
Mailing Address - Phone:225-771-8380
Mailing Address - Fax:225-308-2137
Practice Address - Street 1:8110 SUMMA AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3419
Practice Address - Country:US
Practice Address - Phone:225-771-8380
Practice Address - Fax:225-308-2137
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08715363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily