MEDICARE: LASHAUNDRA I MYERS

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	385H00000X	Respite Care

General Provider Information

NPI Number	:	1265932750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LASHAUNDRA I MYERS

Provider Business Mailing Address
First Line	:	506 W MARION AVE STE F
Second Line	:
City	:	CRYSTAL SPRINGS
State	:	MS
Zip	:	39059-2736
Country	:	US
Telephone Number	:	601-942-2033
Fax Number	:	601-308-5098

Provider Business Practice Location Address
First Line	:	506 W MARION AVE STE F
Second Line	:
City	:	CRYSTAL SPRINGS
State	:	MS
Zip	:	39059-2736
Country	:	US
Telephone Number	:	601-942-2033
Fax Number	:	601-308-5098

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

Provider Enumeration Date	:	02/20/2018
Last Update Date	:	02/20/2018

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