1871927822 NPI number — WILLIAM T LAVELY PMHNP-BC

Table of content: WILLIAM T LAVELY PMHNP-BC (NPI 1871927822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871927822 NPI number — WILLIAM T LAVELY PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAVELY
Provider First Name:
WILLIAM
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PMHNP-BC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871927822
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1507 SPRING STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JEFFERSONVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47130-3554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-901-6881
Provider Business Mailing Address Fax Number:
812-218-9318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1507 SPRING STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSONVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47130-3554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-901-6881
Provider Business Practice Location Address Fax Number:
812-218-9318
Provider Enumeration Date:
08/27/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  71004684A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 3008244 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1063415297 . This is a "GROUP NUMBER - PARK VIEW MD GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1487872636 . This is a "GROUP NUMBER - PARK VIEW ARNP GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201198690 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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