Individual
LATOYA FENE ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
26 BENT TREE CV, JACKSON, TN 38305-8935
(731) 267-0669
Mailing address
161 W UNIVERSITY PKWY # 10861, JACKSON, TN 38305-1857
(731) 265-6787
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
TN
Other
Enumeration date
01/13/2023
Last updated
01/13/2023
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