Provider Demographics
NPI:1477023596
Name:PILLERS, LAVECHELLE (FNP)
Entity Type:Individual
Prefix:
First Name:LAVECHELLE
Middle Name:
Last Name:PILLERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 JENNIFER CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8898
Mailing Address - Country:US
Mailing Address - Phone:769-798-0729
Mailing Address - Fax:
Practice Address - Street 1:5140 GALAXIE DR STE 105
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4354
Practice Address - Country:US
Practice Address - Phone:601-300-3935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-01
Last Update Date:2018-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901938363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty