Provider Demographics
NPI:1992955181
Name:ST. LOUIS, LATERSHA SHERRELL
Entity type:Individual
Prefix:MRS
First Name:LATERSHA
Middle Name:SHERRELL
Last Name:ST. LOUIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LATERSHA
Other - Middle Name:SHERRELL
Other - Last Name:ST. LOUIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:1800 10TH AVE
Mailing Address - Street 2:OUT PATIENT CLINIC DEPT 7510
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-1513
Mailing Address - Country:US
Mailing Address - Phone:706-321-3758
Mailing Address - Fax:706-321-3739
Practice Address - Street 1:1800 10TH AVE
Practice Address - Street 2:OUT PATIENT CLINIC DEPT 7510
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1513
Practice Address - Country:US
Practice Address - Phone:706-321-3758
Practice Address - Fax:706-321-3739
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN 170535363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily