MEDICARE: DENYETTE LATHAM FNP-C

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	363LF0000X	Family Nurse Practitioner	903255	MS

General Provider Information

NPI Number	:	1407319437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENYETTE LATHAM FNP-C

Provider Business Mailing Address
First Line	:	115 N THOMAS ST STE D
Second Line	:
City	:	TUPELO
State	:	MS
Zip	:	38801-3082
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 N THOMAS ST STE D
Second Line	:
City	:	TUPELO
State	:	MS
Zip	:	38801-3082
Country	:	US
Telephone Number	:	601-282-9721
Fax Number	:

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

Provider Enumeration Date	:	04/08/2019
Last Update Date	:	02/26/2026

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