Leticia Marie Ross-Glass
Individual provider Active NPI Driver · Memphis, TN
NPI 1063158798 · NPPES record last updated May 6, 2022
Key facts
- NPI
- 1063158798
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- Practice address
- 3540 Summer Ave Ste 320
Memphis, TN 38122-3600 - Phone
- (901) 623-6220
- NPI assigned
- May 6, 2022
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| J.a.L. Healthcare | Current | Accepting new patients | |
| J.a.L. Supportive Care Homes | Current | Accepting new patients | |
| J.a.L Transportation | Driver | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | Yes |
Addresses
Primary practice location
3540 Summer Ave Ste 320
Memphis, TN 38122-3600
Mailing address
3540 Summer Ave Ste 320
Memphis, TN 38122-3600
Phone (901) 623-6220
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 882060119 | Medicaid | TN |
Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 6, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.