Provider Demographics
NPI:1164902482
Name:GARTH-VILLES, LETISHA A (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LETISHA
Middle Name:A
Last Name:GARTH-VILLES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LETISHA
Other - Middle Name:
Other - Last Name:VILLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1359 GLORIA TRL NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-9572
Mailing Address - Country:US
Mailing Address - Phone:601-748-0405
Mailing Address - Fax:
Practice Address - Street 1:1359 GLORIA TRL NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-9572
Practice Address - Country:US
Practice Address - Phone:601-748-0405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902844363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily