Provider Demographics
NPI:1790134369
Name:CARSTARPHEN, LATOYA M
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:M
Last Name:CARSTARPHEN
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 1:4145 OVERLOOK CIR
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-3848
Mailing Address - Country:US
Mailing Address - Phone:251-593-7035
Mailing Address - Fax:
Practice Address - Street 1:48 MEDICAL PARK DR E
Practice Address - Street 2:SUITE 154
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3400
Practice Address - Country:US
Practice Address - Phone:205-202-5650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-127925363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily