Healthcare Provider Details

I. General information

NPI: 1326408576
Provider Name (Legal Business Name): ADRAVON S HENDERSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADRAVON S WILSON FNP

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2314 S RANGE AVE
DENHAM SPRINGS LA
70726-5216
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 225-480-4080
  • Fax: 866-751-0881
Mailing address:
  • Phone: 305-500-2000
  • Fax: 786-522-9018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08715
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: