Provider Demographics
NPI:1417525270
Name:ALLEN-COSTICT, LATOYA NICHELLE (BSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:LATOYA
Middle Name:NICHELLE
Last Name:ALLEN-COSTICT
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 N HIGH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5377
Mailing Address - Country:US
Mailing Address - Phone:903-234-8755
Mailing Address - Fax:
Practice Address - Street 1:618 N HIGH ST STE 3
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5377
Practice Address - Country:US
Practice Address - Phone:903-234-8755
Practice Address - Fax:903-234-8776
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX914490163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health