Individual
DEAVON ALISHA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1103 KALISTE SALOOM RD STE 208, LAFAYETTE, LA 70508
(337) 234-3757
(337) 234-3733
Mailing address
1103 KALISTE SALOOM RD STE 208, LAFAYETTE, LA 70508-5784
(337) 234-3757
(337) 234-3733
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP07245
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2324217
—
LA
Enumeration date
01/17/2013
Last updated
05/21/2018
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