Provider Demographics
NPI:1205381472
Name:LOVE, LAKEISHA S (FNP- C, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:S
Last Name:LOVE
Suffix:
Gender:F
Credentials:FNP- C, PMHNP-BC
Other - Prefix:
Other - First Name:LAKEISHA
Other - Middle Name:S
Other - Last Name:LOVE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1820 E RAY RD STE A07
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-8720
Mailing Address - Country:US
Mailing Address - Phone:480-526-9292
Mailing Address - Fax:
Practice Address - Street 1:1820 E RAY RD STE A07
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-8720
Practice Address - Country:US
Practice Address - Phone:480-526-9292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTAP8922363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily