Provider Demographics
NPI:1588156145
Name:SMITH, LEKEISHA DELYNN
Entity type:Individual
Prefix:
First Name:LEKEISHA
Middle Name:DELYNN
Last Name:SMITH
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 1:8925 SAGEBRUSH TRL
Mailing Address - Street 2:
Mailing Address - City:CROSSROADS
Mailing Address - State:TX
Mailing Address - Zip Code:76227-3821
Mailing Address - Country:US
Mailing Address - Phone:414-640-3702
Mailing Address - Fax:
Practice Address - Street 1:8925 SAGEBRUSH TRL
Practice Address - Street 2:
Practice Address - City:CROSSROADS
Practice Address - State:TX
Practice Address - Zip Code:76227-3821
Practice Address - Country:US
Practice Address - Phone:414-640-3702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X, 376K00000X
TXNA10082939376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty