Provider Demographics
NPI:1194422162
Name:ANDERSON-LATHAM, KAYANA
Entity type:Individual
Prefix:
First Name:KAYANA
Middle Name:
Last Name:ANDERSON-LATHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:682 S OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-2941
Mailing Address - Country:US
Mailing Address - Phone:614-736-3593
Mailing Address - Fax:
Practice Address - Street 1:682 S OGDEN AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-2941
Practice Address - Country:US
Practice Address - Phone:614-736-3593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide