Provider Demographics
NPI:1528474632
Name:COKER, LA'KEISHA (MS,RD,LD)
Entity type:Individual
Prefix:
First Name:LA'KEISHA
Middle Name:
Last Name:COKER
Suffix:
Gender:F
Credentials:MS,RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 E. CHEVES ST.
Mailing Address - Street 2:FLORENCE COUNTY HEALTH DEPARTMENT
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506
Mailing Address - Country:US
Mailing Address - Phone:843-661-4835
Mailing Address - Fax:843-661-4844
Practice Address - Street 1:145 E. CHEVES ST.
Practice Address - Street 2:FLORENCE COUNTY HEALTH DEPARTMENT
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506
Practice Address - Country:US
Practice Address - Phone:843-661-4835
Practice Address - Fax:843-661-4844
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC997133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC576000286Medicaid