Individual
LATONYA S MIMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2427 LAKECREST DR, SHREVEPORT, LA 71109-3003
(318) 560-2312
Mailing address
2427 LAKECREST DR, SHREVEPORT, LA 71109-3003
(318) 560-2312
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
668574
TX
367500000X
Certified Registered Nurse Anesthetist
RN243434
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110172339A
—
MA
05
—
1195901
—
LA
Enumeration date
11/23/2005
Last updated
02/09/2023
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