1790983955 NPI number — MRS. LATOYA NICOLE DICKENS-JONES DNP, APRN, FNP, ACNP

Table of content: MRS. LATOYA NICOLE DICKENS-JONES DNP, APRN, FNP, ACNP (NPI 1790983955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790983955 NPI number — MRS. LATOYA NICOLE DICKENS-JONES DNP, APRN, FNP, ACNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DICKENS-JONES
Provider First Name:
LATOYA
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DNP, APRN, FNP, ACNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790983955
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2235 TIMES AVE SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44706-2115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-477-2415
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2725 LINCOLN ST E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44707-2769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-454-2000
Provider Business Practice Location Address Fax Number:
330-809-6390
Provider Enumeration Date:
07/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  NP09292 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: NP 09292 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2820577 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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