Provider Demographics
NPI:1083375638
Name:LAKEY, JESSICA JOYCE (LM)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JOYCE
Last Name:LAKEY
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:PENNEY FARMS
Mailing Address - State:FL
Mailing Address - Zip Code:32079-0207
Mailing Address - Country:US
Mailing Address - Phone:904-290-4114
Mailing Address - Fax:
Practice Address - Street 1:534 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-8526
Practice Address - Country:US
Practice Address - Phone:904-290-4114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW424176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife