Provider Demographics
NPI:1518596543
Name:DEBRILL-RICHARDSON, LETITIA A (CNP)
Entity Type:Individual
Prefix:
First Name:LETITIA
Middle Name:A
Last Name:DEBRILL-RICHARDSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6736 GALAXIE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1438
Mailing Address - Country:US
Mailing Address - Phone:937-422-9128
Mailing Address - Fax:
Practice Address - Street 1:30 E APPLE ST STE 5254
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2939
Practice Address - Country:US
Practice Address - Phone:937-208-4200
Practice Address - Fax:937-208-2678
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH377007163WC0200X, 163WC0400X, 163WC1500X, 163WA2000X
OHAPRN.CNP.0033356363LC0200X, 363LA2100X, 363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health