Provider Demographics
NPI:1477926715
Name:LISA A. CHAVIS LLC
Entity Type:Organization
Organization Name:LISA A. CHAVIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC
Authorized Official - Phone:337-501-7737
Mailing Address - Street 1:3116 STANFORD LEVY RD
Mailing Address - Street 2:
Mailing Address - City:DARROLL
Mailing Address - State:LA
Mailing Address - Zip Code:70725
Mailing Address - Country:US
Mailing Address - Phone:337-501-7737
Mailing Address - Fax:
Practice Address - Street 1:3116 STANFORD LEVY RD
Practice Address - Street 2:
Practice Address - City:DARROLL
Practice Address - State:LA
Practice Address - Zip Code:70725
Practice Address - Country:US
Practice Address - Phone:337-501-7737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07584363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA335622YQR7Medicare UPIN