Provider Demographics
NPI:1679049290
Name:DRAIN, LATASHA SHANEIL (NP)
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:SHANEIL
Last Name:DRAIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 CANYON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-3820
Mailing Address - Country:US
Mailing Address - Phone:318-230-3492
Mailing Address - Fax:
Practice Address - Street 1:4701 SAMUELL BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-6828
Practice Address - Country:US
Practice Address - Phone:972-861-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139379363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily