Provider Demographics
NPI:1063079606
Name:SMITH, LAKESHIA
Entity type:Individual
Prefix:
First Name:LAKESHIA
Middle Name:
Last Name:SMITH
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 1:1635 POPPS FERRY RD STE D
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2312
Mailing Address - Country:US
Mailing Address - Phone:228-207-0725
Mailing Address - Fax:228-207-0735
Practice Address - Street 1:1635 POPPS FERRY RD STE D
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2312
Practice Address - Country:US
Practice Address - Phone:228-207-0725
Practice Address - Fax:228-207-0735
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty