Provider Demographics
NPI:1891310074
Name:BYNUM, LATONYA RATESA (CHES)
Entity Type:Individual
Prefix:MRS
First Name:LATONYA
Middle Name:RATESA
Last Name:BYNUM
Suffix:
Gender:F
Credentials:CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3410
Mailing Address - Country:US
Mailing Address - Phone:501-291-8775
Mailing Address - Fax:
Practice Address - Street 1:25 NORTHWOOD DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3410
Practice Address - Country:US
Practice Address - Phone:501-291-8775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR19024174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator