Healthcare Provider Details

I. General information

NPI: 1942560511
Provider Name (Legal Business Name): LATOSHA LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 DAWSON RD
FORREST CITY AR
72335-2088
US

IV. Provider business mailing address

PO BOX 2192
FORREST CITY AR
72336-2192
US

V. Phone/Fax

Practice location:
  • Phone: 870-630-2328
  • Fax: 870-662-6826
Mailing address:
  • Phone: 870-630-2328
  • Fax: 870-662-6826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: