Healthcare Provider Details

I. General information

NPI: 1942136783
Provider Name (Legal Business Name): TIFFANY DEAVER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17544 SALLY AVE
GREENWELL SPRINGS LA
70739-5430
US

IV. Provider business mailing address

17544 SALLY AVE
GREENWELL SPRINGS LA
70739-5430
US

V. Phone/Fax

Practice location:
  • Phone: 865-773-8675
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number30003029
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: