Provider Demographics
NPI:1295343028
Name:WILLIAMS, LATESHA ROCHELLE (NP)
Entity type:Individual
Prefix:
First Name:LATESHA
Middle Name:ROCHELLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 MCSWAIN RD
Mailing Address - Street 2:
Mailing Address - City:NEW AUGUSTA
Mailing Address - State:MS
Mailing Address - Zip Code:39462-9760
Mailing Address - Country:US
Mailing Address - Phone:601-402-0859
Mailing Address - Fax:
Practice Address - Street 1:309 MCSWAIN RD
Practice Address - Street 2:
Practice Address - City:NEW AUGUSTA
Practice Address - State:MS
Practice Address - Zip Code:39462-9760
Practice Address - Country:US
Practice Address - Phone:601-402-0859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903908363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner