Individual
KENYATTA WILLOUGHBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2994 SANDRIDGE AVE, COLUMBUS, OH 43224-6827
(614) 607-8629
Mailing address
2994 SANDRIDGE AVE, COLUMBUS, OH 43224-6827
(614) 607-8629
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
2771460
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163WHO200X
—
OH
Enumeration date
07/20/2014
Last updated
07/20/2014
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