Provider Demographics
NPI:1679449011
Name:HAIRSTON, LATOYA JEANETTE
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:JEANETTE
Last Name:HAIRSTON
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 1:200 DEER STAND DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NC
Mailing Address - Zip Code:27025-8095
Mailing Address - Country:US
Mailing Address - Phone:336-500-2114
Mailing Address - Fax:
Practice Address - Street 1:200 DEER STAND DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NC
Practice Address - Zip Code:27025-8095
Practice Address - Country:US
Practice Address - Phone:336-500-2114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC76683164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse