Healthcare Provider Details

I. General information

NPI: 1376764944
Provider Name (Legal Business Name): LETITIA CANICE THOMPSON-HARGRAVE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LETITIA CANICE THOMPSON D.O.

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CONOVER DR STE B
FRANKLIN OH
45005-1900
US

IV. Provider business mailing address

3420 ATRIUM BLVD STE 102
MIDDLETOWN OH
45005-5186
US

V. Phone/Fax

Practice location:
  • Phone: 513-318-1188
  • Fax: 513-318-1189
Mailing address:
  • Phone: 513-318-1188
  • Fax: 513-318-1189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34008941
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: