Provider Demographics
NPI:1215266416
Name:DAVIS, LAKONNIA YVETTE (LPN)
Entity type:Individual
Prefix:MRS
First Name:LAKONNIA
Middle Name:YVETTE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 S MISSION RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-2034
Mailing Address - Country:US
Mailing Address - Phone:918-894-7947
Mailing Address - Fax:316-612-0602
Practice Address - Street 1:754 S MISSION RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-2034
Practice Address - Country:US
Practice Address - Phone:918-894-7947
Practice Address - Fax:316-612-0602
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-39506-091164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse