Healthcare Provider Details

I. General information

NPI: 1548044035
Provider Name (Legal Business Name): KHANIKA YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KHANIKA RICHARDSON FNP

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 OLD HENDERSON RD STE 120
COLUMBUS OH
43220-7600
US

IV. Provider business mailing address

1170 OLD HENDERSON RD STE 120
COLUMBUS OH
43220-7600
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-3997
  • Fax:
Mailing address:
  • Phone: 614-293-3997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0034348
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: