Deavon Alisha Peterson, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP07245 Issued in LA

Practice address

1103 Kaliste Saloom Rd Ste 208
Lafayette, LA 70508

Phone

(337) 234-3757

Fax

(337) 234-3733

NPI assigned

Jan 17, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Deavon Cormier Peterson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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

{
    "created_epoch": "1358380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526860800000",
    "number": "1760720353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 KALISTE SALOOM RD STE 208",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705085784",
            "telephone_number": "337-234-3757",
            "fax_number": "337-234-3733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 KALISTE SALOOM RD STE 208",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "70508",
            "telephone_number": "337-234-3757",
            "fax_number": "337-234-3733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "DEAVON",
        "middle_name": "ALISHA",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-17",
        "last_updated": "2018-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "AP07245",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2324217",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEAVON",
            "last_name": "PETERSON",
            "middle_name": "CORMIER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Casie Pete
• Morgan A Pete
• Peter D Vizzi MD AMC
• Peter Guidry, DDS, LLC
• Susan Peterman, PLPC, MHP, LPC
• Julio Petilon, M.D.
• Rhode H Petiote, EEG TECH
• Chelsea Rene' Petrolia, APRN
• Jerod Paul Petry, DDS
• Jessica Petry, M.D.

• Family Nurse Practitioner in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Family Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.