Provider Demographics
NPI:1023005725
Name:COLQUITT, LETHA H (FNP)
Entity type:Individual
Prefix:MRS
First Name:LETHA
Middle Name:H
Last Name:COLQUITT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2101 GALLERIA OAKS DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-4625
Mailing Address - Country:US
Mailing Address - Phone:903-614-5390
Mailing Address - Fax:903-223-7089
Practice Address - Street 1:910 JAMES BOWIE DR
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:TX
Practice Address - Zip Code:75570-2335
Practice Address - Country:US
Practice Address - Phone:903-614-5950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX541559363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200327160AMedicaid