Provider Demographics
NPI:1649618869
Name:MARKS, LATISHA SHAMECCA (RD, LD)
Entity type:Individual
Prefix:MS
First Name:LATISHA
Middle Name:SHAMECCA
Last Name:MARKS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 EAST DEBBIE LANE
Mailing Address - Street 2:STE 102 PMB# 184
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3376
Mailing Address - Country:US
Mailing Address - Phone:945-225-3504
Mailing Address - Fax:
Practice Address - Street 1:1301 E DEBBIE LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3305
Practice Address - Country:US
Practice Address - Phone:945-225-3504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007709133V00000X
TXDT88322133V00000X
133VN1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered