Provider Demographics
NPI:1093343691
Name:MCGLOTHIN, KEITHA LATONYA
Entity Type:Individual
Prefix:
First Name:KEITHA
Middle Name:LATONYA
Last Name:MCGLOTHIN
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 1:16523 FM 31
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75672-3606
Mailing Address - Country:US
Mailing Address - Phone:903-407-8475
Mailing Address - Fax:
Practice Address - Street 1:16523 FM 31
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75672-3606
Practice Address - Country:US
Practice Address - Phone:903-407-8475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX150244164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse