Healthcare Provider Details

I. General information

NPI: 1619460870
Provider Name (Legal Business Name): LATASHA GRICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4012 AVENUE H
LAKE CHARLES LA
70615-5186
US

IV. Provider business mailing address

4012 AVENUE H
LAKE CHARLES LA
70615-5186
US

V. Phone/Fax

Practice location:
  • Phone: 337-433-3785
  • Fax:
Mailing address:
  • Phone: 337-433-3786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10159
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP10159
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: