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NPI Code Detail

MEDICARE: LAVONDA LYNETTE HARPER FNP-BC

MEDICARE: LAVONDA LYNETTE HARPER FNP-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
1363LF0000XFamily Nurse Practitioner167887GA

General Provider Information

NPI Number : 1467910067
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAVONDA LYNETTE HARPER FNP-BC
Provider Business Mailing Address
First Line : 1508 LIMA ST
Second Line :
City : GAUTIER
State : MS
Zip : 39553-2702
Country : US
Telephone Number : 678-409-5031
Fax Number : 678-666-1142
Provider Business Practice Location Address
First Line : 2429 MARTIN LUTHER KING JR DR SW
Second Line :
City : ATLANTA
State : GA
Zip : 30311-1713
Country : US
Telephone Number : 404-691-3344
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2019
Last Update Date : 02/06/2026

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