Provider Demographics
NPI:1346574258
Name:OKOTH, JEPHLINE (LPN)
Entity Type:Individual
Prefix:
First Name:JEPHLINE
Middle Name:
Last Name:OKOTH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1558 CUNARD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-3277
Mailing Address - Country:US
Mailing Address - Phone:614-270-9002
Mailing Address - Fax:
Practice Address - Street 1:1558 CUNARD RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-3277
Practice Address - Country:US
Practice Address - Phone:614-270-9002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH128814164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse