Shantel Latta, FNP-C | |
103 E Broad St, Blackstone, VA 23824-1815 | |
(434) 264-3221 | |
Not Available |
Full Name | Shantel Latta |
---|---|
Gender | Female |
Speciality | Nurse Practitioner - Family |
Location | 103 E Broad St, Blackstone, Virginia |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1962092932 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
363LF0000X | Nurse Practitioner - Family | 0024180790 (Virginia) | Primary |
Entity Name | Legacy Care Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1902149776 PECOS PAC ID: 0042458200 Enrollment ID: O20130529000542 |
Entity Name | Little Clinic Of Va Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1225440076 PECOS PAC ID: 2961620596 Enrollment ID: O20140824000049 |
Entity Name | Signify Health Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1689158487 PECOS PAC ID: 3274895263 Enrollment ID: O20210226002383 |
Entity Name | County Med, Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1407580483 PECOS PAC ID: 4082083928 Enrollment ID: O20221215000538 |
Mailing Address | Practice Location Address |
---|---|
Shantel Latta, FNP-C Po Box 635, Blackstone, VA 23824-0635 Ph: () - | Shantel Latta, FNP-C 103 E Broad St, Blackstone, VA 23824-1815 Ph: (434) 264-3221 |
Miss Gabrielle Tiarra Qahhar, NP-C Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 700 Kemper Ave, Blackstone, VA 23824 Phone: 757-310-3925 Fax: 949-863-5677 | |
Allison Noel Lee, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1037 Daniel Rd, Blackstone, VA 23824 Phone: 540-931-6576 | |
Christy T Johnson-oliver, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 213 N Main St, Blackstone, VA 23824 Phone: 434-292-7261 Fax: 434-292-7965 |