Provider Demographics
NPI:1750902623
Name:HORTON, LATESHIA ROCHELLE
Entity type:Individual
Prefix:
First Name:LATESHIA
Middle Name:ROCHELLE
Last Name:HORTON
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 1:1120 PRIMROSE TER
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36703-4130
Mailing Address - Country:US
Mailing Address - Phone:678-879-2616
Mailing Address - Fax:
Practice Address - Street 1:1120 PRIMROSE TER
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36703-4130
Practice Address - Country:US
Practice Address - Phone:678-879-2616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-02
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372500000X, 372600000X
AL376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider
No376K00000XNursing Service Related ProvidersNurse's Aide