Doctor Name: | MS. LATAYATACHA O FREEMAN-ROSS |
NPI Number: | 1184911349 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN-FNP |
License Number: | 009726-7269 |
Business Practice Address: | 808 Johnson St Tallulah, LA - 712824535 |
Business Phone Number: | 3185745080 |
Business Fax Number: | 3185743805 |
Mailing Address: | 808 Johnson St, TALLULAH |
State: | LA |
Postal Code: | 712824535 |
Phone Number: | 3185745080 |
Fax Number: | 3185743805 |
NPI Enumeration Date: | 07/07/2011 |
NPI Last Update Date: | 02/03/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 009726-7269 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |