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General NPI Number Information
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NPI Number | 1437837036
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Entity Type | Individual
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Provider Name | LATARA LEE
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Gender | Female
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Dates
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Enumeration Date | 07/05/2023
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 221 7TH ST N
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City | COLUMBUS
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State | MS
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Zip | 39701-4569
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Country | US
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Telephone | 662-769-1971
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Fax | 662-798-0550
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Provider Business Mailing Address
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Address Line | 1272 JOHN HIGH RD
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City | STARKVILLE
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State | MS
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Zip | 39759-9125
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Country | US
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Telephone |
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Fax | 662-798-0550
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 903510
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 903510
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License Number State | MS
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