Peterson, Deavon Alisha

Peterson, Deavon Alisha is an individual health care provider with primary practice located at 1103 Kaliste Saloom Rd Ste 208 , Lafayette LA 70508. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Peterson, Deavon Alisha can be contacted via phone (337) 234-3757.

Contact Information

Primary practice address
1103 Kaliste Saloom Rd Ste 208 Lafayette LA 70508
Phone: (337) 234-3757
Fax: (337) 234-3733
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X AP07245 Louisiana

Profile Details

NPI number 1760720353
LBN Legal business name Peterson, Deavon Alisha
Credentials FNP-C
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 17th, 2013
Last updated May 21st, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760720353 NPPES
Louisiana MEDICAID 2324217

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