Provider Demographics
NPI:1891886024
Name:PRIVITOR DAVIS, DIANE M (FNP-C, PMHNPBC)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:M
Last Name:PRIVITOR DAVIS
Suffix:
Gender:F
Credentials:FNP-C, PMHNPBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WINTERPARK DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71292-1106
Mailing Address - Country:US
Mailing Address - Phone:318-509-8008
Mailing Address - Fax:318-329-1258
Practice Address - Street 1:1501 STUBBS AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7120
Practice Address - Country:US
Practice Address - Phone:318-816-5116
Practice Address - Fax:318-855-3429
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05002363LF0000X
LAAPO5002363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily