Provider Demographics
NPI:1992384341
Name:WITHERSPOON, LA'TRINA MONIQUE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LA'TRINA
Middle Name:MONIQUE
Last Name:WITHERSPOON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7528 SPRING SPRUCE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-1417
Mailing Address - Country:US
Mailing Address - Phone:980-348-4220
Mailing Address - Fax:
Practice Address - Street 1:3310 SISKEY PKWY
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-3222
Practice Address - Country:US
Practice Address - Phone:704-849-2271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCWITH-WSMI8363LF0000X
NC5014285363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily