Provider Demographics
NPI:1366283640
Name:FLINN, LETASHA
Entity type:Individual
Prefix:
First Name:LETASHA
Middle Name:
Last Name:FLINN
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 1:259 OLIVE BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:RIO
Mailing Address - State:WV
Mailing Address - Zip Code:26755-3542
Mailing Address - Country:US
Mailing Address - Phone:304-268-8392
Mailing Address - Fax:
Practice Address - Street 1:259 OLIVE BRANCH RD
Practice Address - Street 2:
Practice Address - City:RIO
Practice Address - State:WV
Practice Address - Zip Code:26755-3542
Practice Address - Country:US
Practice Address - Phone:304-209-8109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant