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Individual

MS. LATASHA SPENCER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-5579
(601) 984-4151
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-5579
(601) 984-4151

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R876428
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01427849
MS
01
P01668934
RAILROAD MEDICARE
MS
Enumeration date
10/27/2015
Last updated
08/31/2016
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