Individual
KELLY REBECCA LATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
15 MOSS CREEK VLG, HILTON HEAD, SC 29926-1105
(843) 681-5077
Mailing address
11350 MCCORMICK RD, EXECUTIVE PLAZA 1, SUITE 501, HUNT VALLEY, MD 21031-1002
(410) 787-8315
(410) 787-8316
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0005929
MD
Other
Enumeration date
10/05/2015
Last updated
02/06/2019
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