Provider Demographics
NPI:1184857666
Name:JENNINGS, LATONIA ROCHELLE (RN)
Entity Type:Individual
Prefix:
First Name:LATONIA
Middle Name:ROCHELLE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 QUAIL RUN LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-2844
Mailing Address - Country:US
Mailing Address - Phone:972-523-5043
Mailing Address - Fax:972-227-9068
Practice Address - Street 1:7104 CLOVERGLEN DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75249-1433
Practice Address - Country:US
Practice Address - Phone:972-523-5043
Practice Address - Fax:972-227-9068
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities