Provider Demographics
NPI:1003190455
Name:BEXLEY, LATOYA PULLIAM (NP)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:PULLIAM
Last Name:BEXLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 ZACHARY DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-8608
Mailing Address - Country:US
Mailing Address - Phone:770-562-8953
Mailing Address - Fax:
Practice Address - Street 1:410 DIXIE ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3922
Practice Address - Country:US
Practice Address - Phone:678-796-0681
Practice Address - Fax:770-836-8477
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN159472 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily