MEDICARE: LARKEYSHA CHARLTON

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1497481121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARKEYSHA CHARLTON

Provider Business Mailing Address
First Line	:	4910 LONG PIER LN UNIT 101
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-7716
Country	:	US
Telephone Number	:	919-810-9054
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 E 5TH ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-4152
Country	:	US
Telephone Number	:	513-766-9418
Fax Number	:

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

Provider Enumeration Date	:	07/26/2022
Last Update Date	:	08/19/2022

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Directions to “ LARKEYSHA CHARLTON ” Practice Location

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