Provider Demographics
NPI:1023580198
Name:BURNELL, LAKESHA WILSON (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:LAKESHA
Middle Name:WILSON
Last Name:BURNELL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MRS
Other - First Name:LAKESHA
Other - Middle Name:WILSON
Other - Last Name:BURNELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:203 LOUDON HILL DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8531
Mailing Address - Country:US
Mailing Address - Phone:478-550-5789
Mailing Address - Fax:
Practice Address - Street 1:655 7TH ST BLDG 700700A
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31098-2227
Practice Address - Country:US
Practice Address - Phone:478-497-1993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-29
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN148146207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine