Provider Demographics
NPI:1295225654
Name:STARKES, LAKEISHA SHERRAY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:SHERRAY
Last Name:STARKES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2479 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-1807
Mailing Address - Country:US
Mailing Address - Phone:267-455-5162
Mailing Address - Fax:
Practice Address - Street 1:801 WASHINGTON AVE UNIT 21C
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-4716
Practice Address - Country:US
Practice Address - Phone:267-519-9353
Practice Address - Fax:267-519-8120
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN660837163W00000X
PASP018578363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1035875990001Medicaid