Healthcare Provider Details

I. General information

NPI: 1548024144
Provider Name (Legal Business Name): MRS. LATOSHA STEVENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9605 BLOM BLVD
SHREVEPORT LA
71118-4703
US

IV. Provider business mailing address

9605 BLOM BLVD
SHREVEPORT LA
71118-4703
US

V. Phone/Fax

Practice location:
  • Phone: 318-286-7991
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number1072127
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number242857
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: