Healthcare Provider Details

I. General information

NPI: 1285333641
Provider Name (Legal Business Name): EBONI MONIQUE YARBROUGH-CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 03/31/2026
Certification Date: 03/16/2026
Deactivation Date: 03/16/2026
Reactivation Date: 03/31/2026

III. Provider practice location address

6240 STOCKTON TRAIL WA
COLUMBUS OH
43213-4321
US

IV. Provider business mailing address

6240 STOCKTON TRAIL WAY
COLUMBUS OH
43213-4464
US

V. Phone/Fax

Practice location:
  • Phone: 614-405-4104
  • Fax:
Mailing address:
  • Phone: 614-405-4104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberSL528109
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberSL528109
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License NumberRN.517685
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: