Provider Demographics
NPI:1861799983
Name:EDWARDS, LATRICIA NIKIA (CRNP)
Entity type:Individual
Prefix:MRS
First Name:LATRICIA
Middle Name:NIKIA
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CHILDRENS DR
Mailing Address - Street 2:AMBULATORY PEDIATRICS
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2664
Mailing Address - Country:US
Mailing Address - Phone:614-722-4960
Mailing Address - Fax:614-722-4966
Practice Address - Street 1:20620 JOHN CARROLL BLVD STE 214
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-4540
Practice Address - Country:US
Practice Address - Phone:440-622-7444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-101843363LP0200X
OHCOA.11559-NP363LP0200X
OHAPRN.CNP.11559363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0096291Medicaid