Provider Demographics
NPI:1033422639
Name:EALY, LAKESHIA KIJUAN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:LAKESHIA
Middle Name:KIJUAN
Last Name:EALY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7602 GREAT TRINITY FOREST WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-6650
Mailing Address - Country:US
Mailing Address - Phone:469-779-2000
Mailing Address - Fax:877-441-1590
Practice Address - Street 1:7602 GREAT TRINITY FOREST WAY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-6650
Practice Address - Country:US
Practice Address - Phone:469-779-2000
Practice Address - Fax:877-441-1590
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX690537163WH0200X
TXAP137442363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH0200XNursing Service ProvidersRegistered NurseHome Health