Provider Demographics
NPI:1386477875
Name:TEMPLETON, LAKEISHA D'ANN
Entity type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:D'ANN
Last Name:TEMPLETON
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 1:7100 AIRLINE RD UNIT 30143
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79712-7108
Mailing Address - Country:US
Mailing Address - Phone:410-725-9201
Mailing Address - Fax:
Practice Address - Street 1:7100 AIRLINE RD UNIT 30143
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79712-7108
Practice Address - Country:US
Practice Address - Phone:410-725-9201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14191172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker