Provider Demographics
NPI:1043562879
Name:SCOTT, LAKEYSHA LYNNETTE (LPN)
Entity Type:Individual
Prefix:MS
First Name:LAKEYSHA
Middle Name:LYNNETTE
Last Name:SCOTT
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 1:1084 JEFFERSON CHASE WAY
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-9162
Mailing Address - Country:US
Mailing Address - Phone:614-440-3588
Mailing Address - Fax:
Practice Address - Street 1:1084 JEFFERSON CHASE WAY
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-9162
Practice Address - Country:US
Practice Address - Phone:614-440-3588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.147601-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse