Individual
LUCY XAYATHONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
3535 SOUTHERN BLVD, KETTERING, OH 45429-1221
(937) 395-8166
Mailing address
8280 YANKEE ST, CENTERVILLE, OH 45458-1806
(937) 436-4658
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
APRN.CNP.020868
OH
363LA2100X
Acute Care Nurse Practitioner
Primary
APRN.CNP.020868
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0248260
—
OH
Enumeration date
09/28/2017
Last updated
09/06/2024
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