Provider Demographics
NPI:1497284384
Name:SMITH, LAKESHA REGINA (MD)
Entity Type:Individual
Prefix:DR
First Name:LAKESHA
Middle Name:REGINA
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 UNIVERSITY BLVD N APT 41
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-3240
Mailing Address - Country:US
Mailing Address - Phone:904-518-6181
Mailing Address - Fax:904-512-6243
Practice Address - Street 1:2260 UNIVERSITY BLVD N APT 41
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-3240
Practice Address - Country:US
Practice Address - Phone:904-518-6181
Practice Address - Fax:904-512-6243
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171000000X, 372500000X, 176B00000X, 286500000X
172A00000X, 176P00000X, 246YC3302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes286500000XHospitalsMilitary HospitalGroup - Multi-Specialty
No171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Multi-Specialty
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No176P00000XOther Service ProvidersFuneral Director
No246YC3302XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationCoding Specialist, Physician Office Based