Provider Demographics
NPI:1982176962
Name:WILLIAMS, LATASHA PATRICE
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:PATRICE
Last Name:WILLIAMS
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 1:1827 SOUTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-2047
Mailing Address - Country:US
Mailing Address - Phone:318-762-6474
Mailing Address - Fax:
Practice Address - Street 1:1827 SOUTHVIEW DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-2047
Practice Address - Country:US
Practice Address - Phone:318-762-6474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-01
Last Update Date:2019-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20100444164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse