Healthcare Provider Details

I. General information

NPI: 1922402247
Provider Name (Legal Business Name): LATISHA HOUZE-REED FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LATISHA HOUZE FNP-C

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 BRADLEY AVENUE
BEAUMONT MS
39423-0235
US

IV. Provider business mailing address

PO BOX 1729
HATTIESBURG MS
39403-1729
US

V. Phone/Fax

Practice location:
  • Phone: 601-784-3922
  • Fax: 601-784-3755
Mailing address:
  • Phone: 601-545-8700
  • Fax: 601-450-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR864309
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: