Provider Demographics
NPI:1902170988
Name:ALFORD, RESHONDA LATOYA
Entity Type:Individual
Prefix:MS
First Name:RESHONDA
Middle Name:LATOYA
Last Name:ALFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 MEADOWBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-2204
Mailing Address - Country:US
Mailing Address - Phone:769-223-2678
Mailing Address - Fax:
Practice Address - Street 1:1302 MEADOWBROOK AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-2204
Practice Address - Country:US
Practice Address - Phone:769-223-2678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP325240164W00000X
LA20100495164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse