Provider Demographics
NPI:1003296021
Name:CASTILLE, DESHALA LETRECE (DO)
Entity Type:Individual
Prefix:
First Name:DESHALA
Middle Name:LETRECE
Last Name:CASTILLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W 12TH AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-2591
Mailing Address - Country:US
Mailing Address - Phone:620-343-2900
Mailing Address - Fax:
Practice Address - Street 1:1301 W 12TH AVE STE 401
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2591
Practice Address - Country:US
Practice Address - Phone:620-343-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-42400207V00000X
IL125-067325207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology