Healthcare Provider Details

I. General information

NPI: 1811875362
Provider Name (Legal Business Name): LATOSHA LYNETTE WOODFORK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2025
Last Update Date: 08/23/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 TOULON DR
BATON ROUGE LA
70816-5120
US

IV. Provider business mailing address

2720 TOULON DR
BATON ROUGE LA
70816-5120
US

V. Phone/Fax

Practice location:
  • Phone: 225-819-7448
  • Fax:
Mailing address:
  • Phone: 225-819-7448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN825746
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: