Latisha McKenzie, NURSE PRACTITIONER
Individual provider Active NPI Family Nurse Practitioner · Georgetown, GA
NPI 1821769878 · NPPES record last updated Sep 20, 2022
Key facts
- NPI
- 1821769878
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- GAA-NP001043 (GA)
- Practice address
- 23 Old School Rd
Georgetown, GA 39854-4627 - Phone
- (229) 334-9353
- NPI assigned
- Sep 21, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220927002793 | GA | Practitioner - Nurse Practitioner | 9335525450 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Careconnect Health, Inc. | Current |
Accepting new patients | |
| Careconnect Health, Inc. | Current |
Accepting new patients | |
| Corizon Healthcare | Past |
Accepting new patients |
Locations
23 Old School Rd
Georgetown, GA 39854
Phone (229) 334-9353
510 Alston St
Ste B
Richland, GA 31825
Phone (229) 887-3324
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | GAA-NP001043 | GA | Yes |
Addresses
Primary practice location
23 Old School Rd
Georgetown, GA 39854-4627
Mailing address
23 Old School Rd
Georgetown, GA 39854-4627
Phone (229) 334-9353
Other providers in Georgetown, GA
- Careconnect Health, Inc.
- Tempest Keaira Foster
- Yaima Herrera
- Inman Enterprises
- New Horizons CSB Quitman Adult Services
- Quitman County Board of Health
- Quitman County School System
- Stan Lawrence Rentz
- Carmen Campbell Trawick
All providers in Georgetown, GA · Family Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 20, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.