Basic Information
| Provider Information | |||||||||
| NPI: | 1184255440 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | LATASHA | ||||||||
| MiddleName: | NICHOLE | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10950 E FLESHER AVE | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478039628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122397616 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8685 S OLD 41 | ||||||||
| Address2: | |||||||||
| City: | CARLISLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478388234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122683318 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2020 | ||||||||
| LastUpdateDate: | 01/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 28181448A | IN | N | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 71009861A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | F01201392 | 01 | IN | AANP CERTIFICATION | OTHER | 28181448A | 01 | IN | BON INDIANA | OTHER |