MEDICARE: LAVORA BABERS-WILSON APRN-NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN082641AP04551	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326043753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAVORA BABERS-WILSON APRN-NP

Provider Business Mailing Address
First Line	:	321 KEYSER AVE
Second Line	:
City	:	NATCHITOCHES
State	:	LA
Zip	:	71457-5801
Country	:	US
Telephone Number	:	318-356-5566
Fax Number	:	318-356-5596

Provider Business Practice Location Address
First Line	:	1635 MARVEL ST
Second Line	:
City	:	COUSHATTA
State	:	LA
Zip	:	71019
Country	:	US
Telephone Number	:	318-932-2081
Fax Number	:	318-932-2215

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	06/09/2021

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