Healthcare Provider Details
I. General information
NPI: 1407100787
Provider Name (Legal Business Name): NISHA LAVORIAN RICHMOND FNP-C, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 11/07/2012
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1217 NORTH ST
JACKSON MS
39202-2034
US
IV. Provider business mailing address
PO BOX 55826
JACKSON MS
39296-5826
US
V. Phone/Fax
- Phone: 214-810-2696
- Fax: 631-350-0479
- Phone: 704-726-4241
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | 902315 |
| License Number State | MS |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | AP122759 |
| License Number State | TX |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | AP07060 |
| License Number State | LA |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | 95030097 |
| License Number State | CA |
| # 5 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | 902315 |
| License Number State | MS |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | APRN11031906 |
| License Number State | FL |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | AP122759 |
| License Number State | TX |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | APRN.CNP.0036142 |
| License Number State | OH |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | 29961 |
| License Number State | TN |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
