Provider Demographics
NPI:1619439395
Name:COLE, SHERRITTA LATRICE
Entity Type:Individual
Prefix:
First Name:SHERRITTA
Middle Name:LATRICE
Last Name:COLE
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 1:1490 UNION AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3725
Mailing Address - Country:US
Mailing Address - Phone:901-554-9410
Mailing Address - Fax:
Practice Address - Street 1:206 KOLMAR DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38109-1616
Practice Address - Country:US
Practice Address - Phone:901-857-8153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00138751374U00000X
TNI000000028659253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty