Provider Demographics
NPI:1306303888
Name:WRIGHT, LAKRISHA KATRINA
Entity type:Individual
Prefix:
First Name:LAKRISHA
Middle Name:KATRINA
Last Name:WRIGHT
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 1:1121 CARNATION DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-7209
Mailing Address - Country:US
Mailing Address - Phone:205-401-5832
Mailing Address - Fax:
Practice Address - Street 1:1121 CARNATION DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215-7209
Practice Address - Country:US
Practice Address - Phone:205-401-5832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1053877019Medicaid