Latossia Brunell Clark, is a
Dietitian, Registered based in Crawford, Mississippi. Latossia Brunell Clark is licensed to practice in Mississippi (license number 1067835) and her current practice location is
1058 George Bridges Rd, Crawford, Mississippi. She can be reached at her office (for appointments etc.) via phone at
(662) 352-1375.
NPI number for Latossia Brunell Clark is 1932689551 and her current mailing address is 1058 George Bridges Rd, Crawford, Mississippi. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1932689551.
Healthcare Provider's Profile
Full Name | Latossia Brunell Clark |
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Gender | Female |
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Speciality | Dietitian, Registered |
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Location | 1058 George Bridges Rd, Crawford, Mississippi |
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Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
NPI Data:
- NPI Number: 1932689551
- Provider Enumeration Date: 08/14/2018
- Last Update Date: 08/14/2018
Medical Identifiers
Medical identifiers for Latossia Brunell Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1932689551 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
133V00000X | Dietitian, Registered | 1067835 (Mississippi) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Latossia Brunell Clark is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Latossia Brunell Clark, 1058 George Bridges Rd, Crawford, MS 39743-9425 Ph: (662) 352-1375 | Latossia Brunell Clark, 1058 George Bridges Rd, Crawford, MS 39743-9425 Ph: (662) 352-1375 |
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