Provider Demographics
NPI:1982241956
Name:RICHARD, ANDRILL LAVOUR (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ANDRILL
Middle Name:LAVOUR
Last Name:RICHARD
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 1:1198 LEAMAN ST
Mailing Address - Street 2:
Mailing Address - City:CROSS HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29332-4100
Mailing Address - Country:US
Mailing Address - Phone:864-993-6320
Mailing Address - Fax:
Practice Address - Street 1:115 ACADEMY AVENUE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23399363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily