Provider Demographics
NPI:1568956852
Name:MCLEOD, LAKRISTIN GRAHAM
Entity Type:Individual
Prefix:
First Name:LAKRISTIN
Middle Name:GRAHAM
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAKRISTIN
Other - Middle Name:BETH
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5410 HIGHWAY 280
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6501
Mailing Address - Country:US
Mailing Address - Phone:205-512-2361
Mailing Address - Fax:205-278-7660
Practice Address - Street 1:5410 HIGHWAY 280
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-6501
Practice Address - Country:US
Practice Address - Phone:205-512-2361
Practice Address - Fax:205-278-7660
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-123200363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner