Individual
MRS. LISA LATHEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
971 LAKELAND DR, SUITE 557, JACKSON, MS 39216-4643
(601) 200-4560
(601) 326-4632
Mailing address
PO BOX 23666, JACKSON, MS 39225-3666
(601) 200-4749
(601) 200-5929
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R672106
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05721214
—
MS
01
—
P01410915
RAILROAD MEDICARE
MS
Enumeration date
09/09/2009
Last updated
04/30/2015
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