Provider Demographics
NPI:1376806976
Name:RUSSELL, LAKEYA CHARRON (MD)
Entity Type:Individual
Prefix:DR
First Name:LAKEYA
Middle Name:CHARRON
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 986
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-0986
Mailing Address - Country:US
Mailing Address - Phone:919-690-3487
Mailing Address - Fax:919-690-3213
Practice Address - Street 1:110 PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-2576
Practice Address - Country:US
Practice Address - Phone:919-693-6541
Practice Address - Fax:919-693-7396
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301096713207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0107622Medicaid
OH0107622Medicaid