Basic Information
| Provider Information | |||||||||
| NPI: | 1578160867 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | LA'TOYA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1110 CLAY ST | ||||||||
| Address2: | |||||||||
| City: | VICKSBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391832912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6017385820 | ||||||||
| FaxNumber: | 6017385083 | ||||||||
| Practice Location | |||||||||
| Address1: | 1110 CLAY ST | ||||||||
| Address2: | |||||||||
| City: | VICKSBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391832912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6017385820 | ||||||||
| FaxNumber: | 6017385083 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2020 | ||||||||
| LastUpdateDate: | 10/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 325114 | MS | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.