Healthcare Provider Details

I. General information

NPI: 1306470257
Provider Name (Legal Business Name): LATOYA STEPHENS RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2020
Last Update Date: 03/01/2020
Certification Date: 03/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11960 WESTLINE INDUSTRIAL DR STE 201
SAINT LOUIS MO
63146-3209
US

IV. Provider business mailing address

218 HILLVALE DR
CAPE GIRARDEAU MO
63701
US

V. Phone/Fax

Practice location:
  • Phone: 866-433-9555
  • Fax:
Mailing address:
  • Phone: 618-306-2171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number2018019578
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: