Provider Demographics
NPI:1083770960
Name:BROWN, LATOYA
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:BROWN
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 1:21 MELROSE ST
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:AR
Mailing Address - Zip Code:71639
Mailing Address - Country:US
Mailing Address - Phone:870-382-6945
Mailing Address - Fax:
Practice Address - Street 1:2410 HWY 65 N
Practice Address - Street 2:
Practice Address - City:MCGEHEE
Practice Address - State:AR
Practice Address - Zip Code:71654
Practice Address - Country:US
Practice Address - Phone:870-222-3107
Practice Address - Fax:870-222-6741
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator