Provider Demographics
NPI:1962093765
Name:GARRETT, LATASHA SHERE (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:LATASHA
Middle Name:SHERE
Last Name:GARRETT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3169 PLAYERS CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-8835
Mailing Address - Country:US
Mailing Address - Phone:901-410-2090
Mailing Address - Fax:901-410-2251
Practice Address - Street 1:3169 PLAYERS CLUB PKWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-8835
Practice Address - Country:US
Practice Address - Phone:901-410-2090
Practice Address - Fax:901-410-2251
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28766363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health