Healthcare Provider Details

I. General information

NPI: 1932893013
Provider Name (Legal Business Name): MS. LETITIA SHEVON GARRETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9702 W FERRIS BRANCH BLVD APT 532
DALLAS TX
75243-8719
US

IV. Provider business mailing address

9702 W FERRIS BRANCH BLVD APT 532
DALLAS TX
75243-8719
US

V. Phone/Fax

Practice location:
  • Phone: 773-981-2679
  • Fax:
Mailing address:
  • Phone: 773-981-2679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number326176
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: