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General NPI Number Information
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NPI Number | 1215180047
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Entity Type | Individual
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Provider Name | CHRISTIE PHEONA LATHAN FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/24/2008
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 1201 W FRANK AVE
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City | LUFKIN
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State | TX
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Zip | 75904-3357
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Country | US
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Telephone | 936-634-8111
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Fax |
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Provider Business Mailing Address
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Address Line | 204 COUNTY ROAD 120
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City | NACOGDOCHES
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State | TX
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Zip | 75965-8737
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Country | US
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Telephone | 404-274-0414
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | AP130797
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | C-RXN.0101484-C-NP
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | C-APN.0102271-C-NP
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP130797
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License Number State | TX
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