Provider Demographics
NPI:1467185694
Name:LAVALLIE, KIRANA LYNN (NP)
Entity Type:Individual
Prefix:
First Name:KIRANA
Middle Name:LYNN
Last Name:LAVALLIE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2679 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:NY
Mailing Address - Zip Code:12928-2603
Mailing Address - Country:US
Mailing Address - Phone:518-597-3029
Mailing Address - Fax:
Practice Address - Street 1:2679 MAIN ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:NY
Practice Address - Zip Code:12928-2603
Practice Address - Country:US
Practice Address - Phone:518-597-3029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350495363L00000X
390200000X
VT101-0136759363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program