MEDICARE: NISHA LAVORIAN RICHMOND FNP-C, PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	902315	MS
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP122759	TX
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP07060	LA
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95030097	CA
5	363LF0000X	Family Nurse Practitioner	902315	MS
6	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN11031906	FL
7	363LF0000X	Family Nurse Practitioner	AP122759	TX
8	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.0036142	OH
9	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	29961	TN

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	:	1407100787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NISHA LAVORIAN RICHMOND FNP-C, PMHNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 55826
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39296-5826
Country	:	US
Telephone Number	:	704-726-4241
Fax Number	:

Provider Business Practice Location Address
First Line	:	1217 NORTH ST
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39202-2034
Country	:	US
Telephone Number	:	214-810-2696
Fax Number	:	631-350-0479

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

Provider Enumeration Date	:	11/07/2012
Last Update Date	:	12/09/2025

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