Provider Demographics
NPI:1023727864
Name:DELARIVA, LADONNA BAKER (NP)
Entity type:Individual
Prefix:
First Name:LADONNA
Middle Name:BAKER
Last Name:DELARIVA
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 1:160 INGLESIDE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9729
Mailing Address - Country:US
Mailing Address - Phone:601-383-0877
Mailing Address - Fax:
Practice Address - Street 1:3949 MS-43
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047
Practice Address - Country:US
Practice Address - Phone:855-712-7627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905557363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health