Provider Demographics
NPI:1548313653
Name:CHILDRESS, LATARYA MICHELLE (LPN)
Entity type:Individual
Prefix:MS
First Name:LATARYA
Middle Name:MICHELLE
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:LATARYA
Other - Middle Name:MICHELLE
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3619 SNAPWOOD RD APT E
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-6048
Mailing Address - Country:US
Mailing Address - Phone:205-982-1946
Mailing Address - Fax:
Practice Address - Street 1:700 19TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1927
Practice Address - Country:US
Practice Address - Phone:205-558-4766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-055752164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse