Provider Demographics
NPI:1053672881
Name:WHITLEY, LAKESHA LASHAY
Entity Type:Individual
Prefix:MS
First Name:LAKESHA
Middle Name:LASHAY
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 HALBERT ST
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-2607
Mailing Address - Country:US
Mailing Address - Phone:501-332-4400
Mailing Address - Fax:
Practice Address - Street 1:1 STAGECOACH VLG STE 3
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210-4751
Practice Address - Country:US
Practice Address - Phone:501-753-8400
Practice Address - Fax:501-753-8401
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator