Provider Demographics
NPI:1538999164
Name:LOVE, KARLITA BETTY CLAIRE
Entity type:Individual
Prefix:
First Name:KARLITA
Middle Name:BETTY CLAIRE
Last Name:LOVE
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 1:1389 GORHAM DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43223-6202
Mailing Address - Country:US
Mailing Address - Phone:614-772-8636
Mailing Address - Fax:
Practice Address - Street 1:1389 GORHAM DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-6202
Practice Address - Country:US
Practice Address - Phone:614-772-8636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH190504164W00000X
OH400354160404376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse