MEDICARE: LATASHA SHANEIL DRAIN NP

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	AP139379	TX

General Provider Information

NPI Number	:	1679049290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATASHA SHANEIL DRAIN NP

Provider Business Mailing Address
First Line	:	1017 CANYON RIDGE DR
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75115-3820
Country	:	US
Telephone Number	:	318-230-3492
Fax Number	:

Provider Business Practice Location Address
First Line	:	9209 ELAM RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75217-4179
Country	:	US
Telephone Number	:	469-780-2211
Fax Number	:	469-687-9955

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

Provider Enumeration Date	:	10/22/2018
Last Update Date	:	02/04/2026

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