Provider Demographics
NPI:1972197754
Name:BARRETT, LATASHA LYNNETTE
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:LYNNETTE
Last Name:BARRETT
Suffix:
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 1:104 SENIMOR CT
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-8322
Mailing Address - Country:US
Mailing Address - Phone:147-878-5784
Mailing Address - Fax:
Practice Address - Street 1:104 SENIMOR CT
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-8322
Practice Address - Country:US
Practice Address - Phone:147-878-5784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty