Provider Demographics
NPI:1265932750
Name:MYERS, LASHAUNDRA I
Entity type:Individual
Prefix:
First Name:LASHAUNDRA
Middle Name:I
Last Name:MYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 W MARION AVE STE F
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39059-2736
Mailing Address - Country:US
Mailing Address - Phone:601-942-2033
Mailing Address - Fax:601-308-5098
Practice Address - Street 1:506 W MARION AVE STE F
Practice Address - Street 2:
Practice Address - City:CRYSTAL SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39059-2736
Practice Address - Country:US
Practice Address - Phone:601-942-2033
Practice Address - Fax:601-308-5098
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care