Provider Demographics
NPI:1790102333
Name:HARDEN, TIKEITHA COURTNEY (LPN)
Entity Type:Individual
Prefix:
First Name:TIKEITHA
Middle Name:COURTNEY
Last Name:HARDEN
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 1:5713 HORRELL RD
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-2140
Mailing Address - Country:US
Mailing Address - Phone:937-479-2395
Mailing Address - Fax:
Practice Address - Street 1:5713 HORRELL RD
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-2140
Practice Address - Country:US
Practice Address - Phone:937-479-2395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN145892-M-IV376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide