Healthcare Provider Details

I. General information

NPI: 1073268553
Provider Name (Legal Business Name): MS. LATANYA WROTTEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 HIGHWAY 51 N
SOUTHAVEN MS
38671-3636
US

IV. Provider business mailing address

8600 HIGHWAY 51 N
SOUTHAVEN MS
38671-3636
US

V. Phone/Fax

Practice location:
  • Phone: 901-550-3556
  • Fax:
Mailing address:
  • Phone: 901-550-3556
  • Fax: 662-510-2466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number42557
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: