Healthcare Provider Details

I. General information

NPI: 1114701398
Provider Name (Legal Business Name): MRS. LAKITA KELLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 SUMMIT RD STE 111
CINCINNATI OH
45237-2818
US

IV. Provider business mailing address

1821 SUMMIT RD STE 111
CINCINNATI OH
45237-2818
US

V. Phone/Fax

Practice location:
  • Phone: 513-486-8365
  • Fax:
Mailing address:
  • Phone: 513-486-8365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: