Healthcare Provider Details

I. General information

NPI: 1275201444
Provider Name (Legal Business Name): MISS KENYA LAKESHIA CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 EDISON ST
DAYTON OH
45417-1203
US

IV. Provider business mailing address

4130 EDISON ST
DAYTON OH
45417-1203
US

V. Phone/Fax

Practice location:
  • Phone: 937-613-2000
  • Fax:
Mailing address:
  • Phone: 937-613-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: