Provider Demographics
NPI:1801970678
Name:LATHAM, PATRICIA ANN (RD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:LATHAM
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:DORSETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4307
Mailing Address - Country:US
Mailing Address - Phone:940-764-8002
Mailing Address - Fax:940-764-8004
Practice Address - Street 1:1600 10TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4307
Practice Address - Country:US
Practice Address - Phone:940-764-8002
Practice Address - Fax:940-764-8004
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT04363133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT04363OtherREGISTERED DIETICIAN