Provider Demographics
NPI:1396630729
Name:ELLIOTT, LATOYA JEKEMA
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:JEKEMA
Last Name:ELLIOTT
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 1:919 COOPER AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-2009
Mailing Address - Country:US
Mailing Address - Phone:269-910-8087
Mailing Address - Fax:
Practice Address - Street 1:353 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3844
Practice Address - Country:US
Practice Address - Phone:269-330-0664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker