Provider Demographics
NPI:1588342067
Name:VARNELL, LAKESHA
Entity type:Individual
Prefix:MRS
First Name:LAKESHA
Middle Name:
Last Name:VARNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KEISHA
Other - Middle Name:
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPH, PREVENTION SPEC
Mailing Address - Street 1:145 CATHERINE BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-6607
Mailing Address - Country:US
Mailing Address - Phone:601-238-5034
Mailing Address - Fax:
Practice Address - Street 1:145 CATHERINE BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-6607
Practice Address - Country:US
Practice Address - Phone:601-238-5034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS42535171M00000X
MSMS4253533405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention Professional
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty