Provider Demographics
NPI:1093126740
Name:GEORGE, LAKYN ANN
Entity Type:Individual
Prefix:
First Name:LAKYN
Middle Name:ANN
Last Name:GEORGE
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 1:83 MARIWOOD LN
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:AR
Mailing Address - Zip Code:72837-8194
Mailing Address - Country:US
Mailing Address - Phone:479-264-1516
Mailing Address - Fax:
Practice Address - Street 1:83 MARIWOOD LN
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:AR
Practice Address - Zip Code:72837-8194
Practice Address - Country:US
Practice Address - Phone:479-264-1516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator