William Provosty, MD

Primary specialty

Forensic Psychiatry PhysicianTaxonomy code 2084F0202X

License

A200462 Issued in CA

Practice address

PO Box 86125
Los Angeles, CA 90086-0125

Phone

(323) 409-4942

NPI assigned

Feb 26, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1582675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762732800000",
    "number": "1003440223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 86125",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900860125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 86125",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900860125",
            "telephone_number": "323-409-4942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVOSTY",
        "first_name": "WILLIAM",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-02-26",
        "last_updated": "2025-11-10",
        "certification_date": "2025-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084F0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Forensic Psychiatry",
            "state": "CA",
            "license": "A200462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taryn Provinchain
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• Tarra Provisor
• Jackie Provost, MPH
• Pigeon Provost
• PRT RX, Inc.
• Meagan Victoria Jean Pruden, PMHNP-BC
• Brenda Maria Prudencio, MA
• Jamie Michelle Lalis Prudencio
• Jerome Prudencio Jr.

• Forensic Psychiatry Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Forensic Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.