Provider Demographics
NPI:1851857494
Name:SPEED, LATARA CHENAY (LICENSED NURSE)
Entity Type:Individual
Prefix:MISS
First Name:LATARA
Middle Name:CHENAY
Last Name:SPEED
Suffix:
Gender:F
Credentials:LICENSED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 ARGONNE DR NE
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:AL
Mailing Address - Zip Code:35215-5711
Mailing Address - Country:US
Mailing Address - Phone:205-266-7623
Mailing Address - Fax:
Practice Address - Street 1:201 MAMIE LN
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215-7107
Practice Address - Country:US
Practice Address - Phone:205-266-7623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
AL2-057153164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide