Provider Demographics
NPI:1871013359
Name:SHEFFIELD, LATICIA KAY (APRN)
Entity Type:Individual
Prefix:
First Name:LATICIA
Middle Name:KAY
Last Name:SHEFFIELD
Suffix:
Gender:F
Credentials:APRN
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 735
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AR
Mailing Address - Zip Code:72722-0735
Mailing Address - Country:US
Mailing Address - Phone:479-752-3233
Mailing Address - Fax:479-752-3235
Practice Address - Street 1:346 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AR
Practice Address - Zip Code:72722-9732
Practice Address - Country:US
Practice Address - Phone:479-752-3233
Practice Address - Fax:479-752-3235
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005158207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1023028016OtherGROUP NPI