Provider Demographics
NPI:1336767375
Name:POLK, LAKESHA (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:MRS
First Name:LAKESHA
Middle Name:
Last Name:POLK
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2487 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38127-8351
Mailing Address - Country:US
Mailing Address - Phone:901-239-1020
Mailing Address - Fax:
Practice Address - Street 1:3584 FORREST AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-5123
Practice Address - Country:US
Practice Address - Phone:901-323-2709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN969821744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management