MEDICARE: LATISHA M FLEMING R.N., N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R871285	MS

General Provider Information

NPI Number	:	1205128725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATISHA M FLEMING R.N., N.P.

Provider Business Mailing Address
First Line	:	2101 HIGHWAY 90
Second Line	:
City	:	GAUTIER
State	:	MS
Zip	:	39553-5340
Country	:	US
Telephone Number	:	228-497-7576
Fax Number	:	228-497-8869

Provider Business Practice Location Address
First Line	:	1270 OCEAN SPRINGS RD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3409
Country	:	US
Telephone Number	:	228-875-3033
Fax Number	:	228-875-3989

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2011
Last Update Date	:	11/05/2024

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