Provider Demographics
NPI:1861039174
Name:HINTON, LATASHA KAYE I
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:KAYE
Last Name:HINTON
Suffix:I
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 1:105 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SMACKOVER
Mailing Address - State:AR
Mailing Address - Zip Code:71762-1817
Mailing Address - Country:US
Mailing Address - Phone:870-590-5040
Mailing Address - Fax:
Practice Address - Street 1:105 W 8TH ST
Practice Address - Street 2:
Practice Address - City:SMACKOVER
Practice Address - State:AR
Practice Address - Zip Code:71762-1817
Practice Address - Country:US
Practice Address - Phone:870-590-5040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR050152270101E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide