Provider Demographics
NPI:1568139665
Name:JOHNSON, LAKASHIA (LVN)
Entity Type:Individual
Prefix:
First Name:LAKASHIA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 HEATHER LN APT B
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-4892
Mailing Address - Country:US
Mailing Address - Phone:254-317-0673
Mailing Address - Fax:
Practice Address - Street 1:4805 HEATHER LN APT B
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4892
Practice Address - Country:US
Practice Address - Phone:254-317-0673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX304647164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse