Basic Information
| Provider Information | |||||||||
| NPI: | 1962567255 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LATTIMORE | ||||||||
| FirstName: | JUDY | ||||||||
| MiddleName: | FAYE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 214 | ||||||||
| Address2: | |||||||||
| City: | MCGEHEE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 71654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702223803 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2410 HWY 65N | ||||||||
| Address2: | |||||||||
| City: | MCGEHEE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 71654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702223107 | ||||||||
| FaxNumber: | 8702226741 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | R63251 | AR | Y | Nursing Service Providers | Registered Nurse |
No ID Information.