Healthcare Provider Details

I. General information

NPI: 1326589318
Provider Name (Legal Business Name): LATASHA RACHELL MARTIN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2017
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 PYRAMID PL STE 417
MEMPHIS TN
38132-1703
US

IV. Provider business mailing address

1840 PYRAMID PL STE 417
MEMPHIS TN
38132-1703
US

V. Phone/Fax

Practice location:
  • Phone: 901-675-7075
  • Fax: 901-425-9755
Mailing address:
  • Phone: 901-675-7075
  • Fax: 901-425-9755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number22313
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: