Provider Demographics
NPI:1184772931
Name:AMOS, LATISHA RENEA (DC, FNP)
Entity type:Individual
Prefix:DR
First Name:LATISHA
Middle Name:RENEA
Last Name:AMOS
Suffix:
Gender:F
Credentials:DC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S 9TH ST STE 115
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-3448
Mailing Address - Country:US
Mailing Address - Phone:281-239-2700
Mailing Address - Fax:281-239-2703
Practice Address - Street 1:301 S 9TH ST STE 115
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3448
Practice Address - Country:US
Practice Address - Phone:281-344-2400
Practice Address - Fax:281-344-2401
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX522352314OtherTAX ID
TXF06182646OtherADVANCE PRACTICE REGISTER NURSE