Healthcare Provider Details

I. General information

NPI: 1669214102
Provider Name (Legal Business Name): STEPHANIE LATORIA DUKES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3512 MEIER DR
MEMPHIS TN
38118-7243
US

IV. Provider business mailing address

3512 MEIER DR
MEMPHIS TN
38118-7243
US

V. Phone/Fax

Practice location:
  • Phone: 262-497-0790
  • Fax:
Mailing address:
  • Phone: 262-497-0790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number916942
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number916942
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code163WC3500X
TaxonomyCardiac Rehabilitation Registered Nurse
License Number161798
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code163WF0300X
TaxonomyFlight Registered Nurse
License Number161798
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number916942
License Number StateMS
# 6
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number4189
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number161798
License Number StateWI
# 8
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number916942
License Number StateMS
# 9
Primary TaxonomyN
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License Number916942
License Number StateMS
# 10
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number916942
License Number StateMS
# 11
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number916942
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: