Provider Demographics
NPI:1871841312
Name:LATHAM, AMBER LOVE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LOVE
Last Name:LATHAM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 AUSTIN DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-9670
Mailing Address - Country:US
Mailing Address - Phone:704-472-8025
Mailing Address - Fax:
Practice Address - Street 1:105 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-9543
Practice Address - Country:US
Practice Address - Phone:704-434-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC105011363LF0000X
NC5005793363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily