Healthcare Provider Details

I. General information

NPI: 1790486645
Provider Name (Legal Business Name): LATSHIE SHRELL KNOX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2023
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 BRICK ROW DR APT 2156
RICHARDSON TX
75081-4908
US

IV. Provider business mailing address

744 BRICK ROW DR APT 2156
RICHARDSON TX
75081-4908
US

V. Phone/Fax

Practice location:
  • Phone: 214-946-0810
  • Fax:
Mailing address:
  • Phone: 214-946-0810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: