MEDICARE: LATISHA FLETCHER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1174227722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATISHA FLETCHER

Provider Business Mailing Address
First Line	:	5528 1ST AVE S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35212-2563
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5528 1ST AVE S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35212-2563
Country	:	US
Telephone Number	:	205-882-0971
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2023
Last Update Date	:	03/28/2023

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Directions to “ LATISHA FLETCHER ” Practice Location

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