Provider Demographics
NPI:1457841330
Name:HARRIS, LAKEESHA ASHLEY
Entity Type:Individual
Prefix:
First Name:LAKEESHA
Middle Name:ASHLEY
Last Name:HARRIS
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 1:8813 WESTBROOK PL
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71108-6023
Mailing Address - Country:US
Mailing Address - Phone:318-210-1392
Mailing Address - Fax:
Practice Address - Street 1:8813 WESTBROOK PL
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71108-6023
Practice Address - Country:US
Practice Address - Phone:318-210-1392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01972375343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA008321370OtherLA DRIVERS LICENSE