Healthcare Provider Details

I. General information

NPI: 1164727319
Provider Name (Legal Business Name): LATOYA SHANTA HENDERSON APRN, FNP, PMH-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 E MARKET ST
AKRON OH
44305-2421
US

IV. Provider business mailing address

725 E MARKET ST
AKRON OH
44305-2421
US

V. Phone/Fax

Practice location:
  • Phone: 330-434-4141
  • Fax:
Mailing address:
  • Phone: 330-434-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.365153
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.026034
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2022090854
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: