Provider Demographics
NPI:1033679683
Name:JONES, LAKEISHA (LPN)
Entity Type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CEDAR TREE CT APT G
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-4256
Mailing Address - Country:US
Mailing Address - Phone:770-990-0095
Mailing Address - Fax:
Practice Address - Street 1:1618 N BROADWAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-2315
Practice Address - Country:US
Practice Address - Phone:770-990-0095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251G00000X, 261QM0850X, 310400000X, 320800000X, 385H00000X
MDLP53051164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No251G00000XAgenciesHospice Care, Community Based
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No385H00000XRespite Care FacilityRespite Care