Healthcare Provider Details

I. General information

NPI: 1205746930
Provider Name (Legal Business Name): LAVONTE N COLVIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAVONTE NICOLE CLINES

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 BABBLE CREEK LN
O FALLON MO
63368-8334
US

IV. Provider business mailing address

2660 BABBLE CREEK LN
O FALLON MO
63368-8334
US

V. Phone/Fax

Practice location:
  • Phone: 314-400-0442
  • Fax:
Mailing address:
  • Phone: 314-400-0442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: