Provider Demographics
NPI:1821979824
Name:GRASPER, LA CHENDARA
Entity type:Individual
Prefix:
First Name:LA CHENDARA
Middle Name:
Last Name:GRASPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 WHITEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-2627
Mailing Address - Country:US
Mailing Address - Phone:228-355-7061
Mailing Address - Fax:
Practice Address - Street 1:1410 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553-5449
Practice Address - Country:US
Practice Address - Phone:228-355-7061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty