Provider Demographics
NPI:1497942007
Name:GIPSON, LATOYA P (WHNP)
Entity Type:Individual
Prefix:MRS
First Name:LATOYA
Middle Name:P
Last Name:GIPSON
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:MISS
Other - First Name:LATOYA
Other - Middle Name:R
Other - Last Name:PARTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP
Mailing Address - Street 1:8001 YOUREE DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2302
Mailing Address - Country:US
Mailing Address - Phone:318-212-3890
Mailing Address - Fax:318-212-3888
Practice Address - Street 1:8001 YOUREE DR
Practice Address - Street 2:SUITE 600
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2302
Practice Address - Country:US
Practice Address - Phone:318-212-3890
Practice Address - Fax:318-212-3888
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN106410 AP05276363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1017914Medicaid
LA1017914Medicaid