Healthcare Provider Details

I. General information

NPI: 1619775889
Provider Name (Legal Business Name): ALYSSA DUCKWORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 STEWART AVE
COLUMBUS OH
43206-2950
US

IV. Provider business mailing address

780 STEWART AVE
COLUMBUS OH
43206-2950
US

V. Phone/Fax

Practice location:
  • Phone: 614-795-7591
  • Fax:
Mailing address:
  • Phone: 614-795-7591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number184292
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: