Healthcare Provider Details

I. General information

NPI: 1235854092
Provider Name (Legal Business Name): LATOYKA S CLEMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2917 FALCON BRIDGE DR
COLUMBUS OH
43232-5438
US

IV. Provider business mailing address

2917 FALCON BRIDGE DR
COLUMBUS OH
43232-5438
US

V. Phone/Fax

Practice location:
  • Phone: 614-425-5592
  • Fax:
Mailing address:
  • Phone: 614-425-5592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number602347270822
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: