Provider Demographics
NPI:1598297467
Name:FAULKNER, LATOSHA S
Entity type:Individual
Prefix:MS
First Name:LATOSHA
Middle Name:S
Last Name:FAULKNER
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 1:8151 WALNUT GROVE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4286
Mailing Address - Country:US
Mailing Address - Phone:901-273-6433
Mailing Address - Fax:
Practice Address - Street 1:8151 WALNUT GROVE RD STE 2
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4286
Practice Address - Country:US
Practice Address - Phone:901-273-6433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care