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Individual

DR. LAVON FENDERSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DNP, FNP-BC

Contact information

Practice address
2858 SUNSET BLVD, WEST COLUMBIA, SC 29169-3420
(803) 699-9073
Mailing address
2858 SUNSET BLVD, WEST COLUMBIA, SC 29169-3420

Taxonomy

Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
18887
SC
363LF0000X
Family Nurse Practitioner
Primary
18897
SC
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
18887
SC

Other

Enumeration date
07/09/2014
Last updated
07/09/2025
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