Provider Demographics
NPI:1740825603
Name:FRANCIS, ANITRA LA'TRICE
Entity type:Individual
Prefix:
First Name:ANITRA
Middle Name:LA'TRICE
Last Name:FRANCIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANITRA
Other - Middle Name:LA'TRICE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:200 STERLING DR
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1567
Mailing Address - Country:US
Mailing Address - Phone:318-628-0016
Mailing Address - Fax:
Practice Address - Street 1:200 STERLING DR
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1567
Practice Address - Country:US
Practice Address - Phone:318-628-0016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX98069163W00000X
KY4029799363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse