Provider Demographics
NPI:1851960819
Name:POPPLEWELL, LATISHA ANN (NP-C)
Entity Type:Individual
Prefix:
First Name:LATISHA
Middle Name:ANN
Last Name:POPPLEWELL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1610
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-1610
Mailing Address - Country:US
Mailing Address - Phone:270-866-4141
Mailing Address - Fax:270-866-4140
Practice Address - Street 1:153 DOWELL RD
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-4579
Practice Address - Country:US
Practice Address - Phone:270-866-4141
Practice Address - Fax:270-866-4140
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016288363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily