Provider Demographics
NPI:1669405262
Name:LAVIS, NICOLE KORIN (PA-C)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:KORIN
Last Name:LAVIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12051 ASHEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:INMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29349
Mailing Address - Country:US
Mailing Address - Phone:864-708-3485
Mailing Address - Fax:864-708-3487
Practice Address - Street 1:12051 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:INMAN
Practice Address - State:SC
Practice Address - Zip Code:29349
Practice Address - Country:US
Practice Address - Phone:864-708-3485
Practice Address - Fax:864-708-3487
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPA 1645363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant