Provider Demographics
NPI:1184772931
Name:AMOS, LATISHA RENEA (DC, FNP)
Entity type:Individual
Prefix:DR
First Name:LATISHA
Middle Name:RENEA
Last Name:AMOS
Suffix:
Gender:F
Credentials:DC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8055 FM 359 RD S UNIT 323
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-1313
Mailing Address - Country:US
Mailing Address - Phone:832-216-2244
Mailing Address - Fax:
Practice Address - Street 1:606 WALLER AVE
Practice Address - Street 2:
Practice Address - City:BROOKSHIRE
Practice Address - State:TX
Practice Address - Zip Code:77423-9371
Practice Address - Country:US
Practice Address - Phone:281-934-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8885111N00000X
TXAP138721363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX522352314OtherTAX ID
TXF06182646OtherADVANCE PRACTICE REGISTER NURSE