Healthcare Provider Details

I. General information

NPI: 1093551491
Provider Name (Legal Business Name): NIKITA L WARFIELD-OWENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2024
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 MARKET ST STE 203
BOARDMAN OH
44512-2624
US

IV. Provider business mailing address

5500 MARKET ST STE 203
BOARDMAN OH
44512-2624
US

V. Phone/Fax

Practice location:
  • Phone: 330-330-8332
  • Fax: 234-201-8390
Mailing address:
  • Phone: 330-330-8332
  • Fax: 234-201-8390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License NumberOCPS.161478
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: