Individual
LATISHA MONIQUE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10584 STEEPLECHASE DR, GULFPORT, MS 39503-4279
(228) 297-3720
Mailing address
10584 STEEPLECHASE DR, GULFPORT, MS 39503-4279
(228) 297-3720
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/21/2022
Last updated
05/14/2022
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