Provider Demographics
NPI:1285333641
Name:YARBROUGH-CARTER, EBONI MONIQUE
Entity type:Individual
Prefix:
First Name:EBONI
Middle Name:MONIQUE
Last Name:YARBROUGH-CARTER
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 1:6240 STOCKTON TRAIL WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-4464
Mailing Address - Country:US
Mailing Address - Phone:614-405-4104
Mailing Address - Fax:
Practice Address - Street 1:6240 STOCKTON TRAIL WA
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-4321
Practice Address - Country:US
Practice Address - Phone:614-405-4104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSL528109347C00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN.517685OtherNURSING