Latrice Shonta Mallard, MAM, APRN, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

229471 Issued in LA

Practice address

721 Avenue G
Kentwood, LA 70444-2601

Phone

(225) 315-1357

NPI assigned

May 15, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• HIV-AIDS Alliance for Region Two

  • Federally Qualified Health Center (FQHC)
  • Baton Rouge, LA
  • NPI 1437527900
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1494806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681344000000",
    "number": "1225565807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40984",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708350984",
            "telephone_number": "225-315-1357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 AVENUE G",
            "city": "KENTWOOD",
            "state": "LA",
            "postal_code": "704442601",
            "telephone_number": "225-315-1357"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "711 Colonial Dr Ste D",
            "address_purpose": "LOCATION",
            "city": "Baton Rouge",
            "state": "LA",
            "postal_code": "708066549",
            "country_code": "US",
            "telephone_number": "225-246-2162",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALLARD",
        "first_name": "LATRICE",
        "middle_name": "SHONTA",
        "name_prefix": "Ms.",
        "credential": "MAM, APRN, PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-05-15",
        "last_updated": "2023-04-13",
        "certification_date": "2023-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "LA",
            "license": "117290",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "LA",
            "license": "229471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kentwood Manor Nursing Home, L.L.C.
• Carmen Kinzy, LPC
• Lets Keep It Moving Transportation
• Louisiana Step Up Organization
• Julian Lowe
• Crystal R Miller, LCSW
• Shelby Miller II
• MJ Smith Entity LLC
• Kerneisha Murphy, DNP, APRN, FNP-BC
• Sarah Notariano

• Psychiatric/Mental Health Nurse Practitioner in Kentwood, LA
• Providers in Kentwood, LA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.