Provider Demographics
NPI:1063970333
Name:HARDEMON, LAKEITHIA (RN)
Entity type:Individual
Prefix:
First Name:LAKEITHIA
Middle Name:
Last Name:HARDEMON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 PAR DR APT 3621
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-6786
Mailing Address - Country:US
Mailing Address - Phone:817-403-9448
Mailing Address - Fax:
Practice Address - Street 1:5001 PAR DR APT 3621
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-6786
Practice Address - Country:US
Practice Address - Phone:817-403-9448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX960458163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse