Provider Demographics
NPI:1326806761
Name:LATIMORE-SCOTT, NETRC
Entity Type:Individual
Prefix:
First Name:NETRC
Middle Name:
Last Name:LATIMORE-SCOTT
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 1:19411 HELENBIRG RD STE 201
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5199
Mailing Address - Country:US
Mailing Address - Phone:225-413-0513
Mailing Address - Fax:
Practice Address - Street 1:19411 HELENBIRG RD STE 201
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5199
Practice Address - Country:US
Practice Address - Phone:225-413-0513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker