Latrisha Hollmon

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

043.116475 Issued in IL

Practice address

7050 Centennial Dr
Tinley Park, IL 60477-1649

Phone

(708) 535-6812

NPI assigned

Nov 2, 2022

Last updated

Nov 2, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1667347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667347200000",
    "number": "1831806553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3813 169TH ST",
            "city": "COUNTRY CLUB HILLS",
            "state": "IL",
            "postal_code": "604782137",
            "telephone_number": "773-406-7564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7050 CENTENNIAL DR",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604771649",
            "telephone_number": "708-535-6812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLMON",
        "first_name": "LATRISHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-02",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "IL",
            "license": "043.116475",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Licensed Practical Nurse in Tinley Park, IL
• Providers in Tinley Park, IL by specialty
• Licensed Practical Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.