Healthcare Provider Details

I. General information

NPI: 1326043753
Provider Name (Legal Business Name): LAVORA BABERS-WILSON APRN-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 MARVEL ST
COUSHATTA LA
71019
US

IV. Provider business mailing address

321 KEYSER AVE
NATCHITOCHES LA
71457-5801
US

V. Phone/Fax

Practice location:
  • Phone: 318-932-2081
  • Fax: 318-932-2215
Mailing address:
  • Phone: 318-356-5566
  • Fax: 318-356-5596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN082641AP04551
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: