MEDICARE: LATAYA DE JESUS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	4044149	KY
2	363LF0000X	Family Nurse Practitioner	1214857	TX
3	363LF0000X	Family Nurse Practitioner	327525	AZ
4	363LF0000X	Family Nurse Practitioner	113014	WV
5	363LF0000X	Family Nurse Practitioner	APRN.CNP.0031356	OH
6	363LF0000X	Family Nurse Practitioner	5024121	NC
7	405300000X	Prevention Professional	0000837	OH

General Provider Information

NPI Number	:	1154071264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATAYA DE JESUS NP

Provider Business Mailing Address
First Line	:	416 COLEGATE DR BLDG 3
Second Line	:
City	:	MARIETTA
State	:	OH
Zip	:	45750-9549
Country	:	US
Telephone Number	:	740-374-3526
Fax Number	:	740-374-3165

Provider Business Practice Location Address
First Line	:	807 FARSON ST STE 203A
Second Line	:
City	:	BELPRE
State	:	OH
Zip	:	45714-1069
Country	:	US
Telephone Number	:	740-568-5687
Fax Number	:	740-376-6118

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	03/18/2026

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Directions to “ LATAYA DE JESUS NP” Practice Location

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