Provider Demographics
NPI:1326392671
Name:MCDANIEL, LAKISHA A (FNP)
Entity Type:Individual
Prefix:
First Name:LAKISHA
Middle Name:A
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W KEISER AVE
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:AR
Mailing Address - Zip Code:72370-3506
Mailing Address - Country:US
Mailing Address - Phone:870-563-6512
Mailing Address - Fax:870-563-5013
Practice Address - Street 1:216 ARKANSAS ST
Practice Address - Street 2:
Practice Address - City:EARLE
Practice Address - State:AR
Practice Address - Zip Code:72331-2217
Practice Address - Country:US
Practice Address - Phone:870-792-7676
Practice Address - Fax:870-792-7676
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17083363LF0000X
ARA003767363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN17083OtherFAMILY NURSE PRACTITIONER