Provider Demographics
NPI:1932172574
Name:JARRETT, LATASHA NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:LATASHA
Middle Name:NICOLE
Last Name:JARRETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2332 BEVERLY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76114-1756
Mailing Address - Country:US
Mailing Address - Phone:817-378-0855
Mailing Address - Fax:817-378-0861
Practice Address - Street 1:2332 BEVERLY HILLS DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76114-1756
Practice Address - Country:US
Practice Address - Phone:817-378-0855
Practice Address - Fax:817-378-0861
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1163207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177536302Medicaid
TXI38791Medicare UPIN
TX177536302Medicaid