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NPI Code Detail

MEDICARE: MRS. LATOYA SHANTA HENDERSON APRN, FNP, PMH-NP

MEDICARE: MRS. LATOYA SHANTA HENDERSON APRN, FNP, PMH-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
1163W00000XRegistered NurseRN.365153OH
2363LF0000XFamily Nurse PractitionerAPRN.CNP.026034OH
3363LP0808XPsychiatric/Mental Health Nurse Practitioner2022090854OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164727319
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LATOYA SHANTA HENDERSON APRN, FNP, PMH-NP
Provider Business Mailing Address
First Line : 725 E MARKET ST
Second Line :
City : AKRON
State : OH
Zip : 44305-2421
Country : US
Telephone Number : 330-434-4141
Fax Number :
Provider Business Practice Location Address
First Line : 725 E MARKET ST
Second Line :
City : AKRON
State : OH
Zip : 44305-2421
Country : US
Telephone Number : 330-434-4141
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2011
Last Update Date : 01/23/2026

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