Healthcare Provider Details

I. General information

NPI: 1982300638
Provider Name (Legal Business Name): LATECIA ELSTON RHODEN AGACRNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 NORTH ST E
TALLADEGA AL
35160-2529
US

IV. Provider business mailing address

204 SUNLIGHT CIR
TALLADEGA AL
35160-2690
US

V. Phone/Fax

Practice location:
  • Phone: 256-362-3636
  • Fax: 256-649-3361
Mailing address:
  • Phone: 256-375-5479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-146018
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-146018
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: