Provider Demographics
NPI:1124730700
Name:KNUCKLES, LAKISHA D
Entity type:Individual
Prefix:MRS
First Name:LAKISHA
Middle Name:D
Last Name:KNUCKLES
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 1:3010 E 81ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OK
Mailing Address - Zip Code:44104
Mailing Address - Country:US
Mailing Address - Phone:216-466-2361
Mailing Address - Fax:
Practice Address - Street 1:3010 E 81ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OK
Practice Address - Zip Code:44104
Practice Address - Country:US
Practice Address - Phone:216-466-2361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver