Individual provider Active NPI

Laura Jean Lata, N.P.

  • Nurse Practitioner
  • Bonners Ferry, ID
National Provider Identifier
1649224783
Registry record updated Jul 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
NP-1047A Issued in ID
Practice address
6615 Comanche Street
Bonners Ferry, ID 83805
Phone
(931) 879-5864
Fax
(931) 879-3903
NPI assigned
May 22, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NP-1047A ID Primary
Nurse Practitioner 363L00000X 12540 TN

Addresses

Primary practice location

6615 Comanche Street
Bonners Ferry, ID 83805

Mailing address

PO Box 2861
Crossville, TN 38557-2861
Phone (931) 879-5864

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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

Enrollment IDStateProvider typePAC IDDetails
I20241024000380 TN Practitioner - Nurse Practitioner 0446213763 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Acute Care Clinics of America, LLCGroup PAC ID 6305273392, 8 clinicians

Practice addresses (Care Compare)

100 S Duncan St
Jamestown, TN 38556-3009
Phone (931) 879-5864

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
003106CTMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Acute Care Clinics of America, LLC CurrentSince Nov 1, 2025 Accepting new patients
Primary Care of Jamestown, LLC CurrentSince Nov 1, 2025 Accepting new patients
Monterey Medical LLC CurrentSince Apr 1, 2026 Accepting new patients
Healthwise Medical Associates, LLP Past Accepting new patients
Prohealth Physicians PC Nurse Practitioner Past Accepting new patients

Locations

6845 S York Hwy
Clarkrange, TN 38553
Phone (931) 863-3323

100 S Duncan St
Jamestown, TN 38556
Phone (931) 752-2273

101 S Duncan St
Ste C
Jamestown, TN 38556

400 W Crawford Ave
Ste C
Monterey, TN 38574
Phone (931) 839-2224

Interoperability endpoints

  • Direct secure messaging: laura.lata.p1@direct.kch.nextgenshare.com
  • Direct secure messaging: laura.lata@4297.securemail.mdnavigatorclinical.com

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785196800000",
    "number": "1649224783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2861",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385572861",
            "telephone_number": "931-879-5864",
            "fax_number": "931-879-3903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6615 COMANCHE STREET",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "83805",
            "telephone_number": "931-879-5864",
            "fax_number": "931-879-3903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LATA",
        "first_name": "LAURA",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-22",
        "last_updated": "2026-07-28",
        "certification_date": "2026-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": "NP-1047A",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "12540",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bonners Ferry, ID

Sources for this page

Verify at the official NPI Registry.