Provider Demographics
NPI:1609119452
Name:KENETI, LAKEISHA (DNP,FNP-C, PMH-BC)
Entity Type:Individual
Prefix:DR
First Name:LAKEISHA
Middle Name:
Last Name:KENETI
Suffix:
Gender:F
Credentials:DNP,FNP-C, PMH-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2470 PRUDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-4206
Mailing Address - Country:US
Mailing Address - Phone:757-922-8048
Mailing Address - Fax:757-922-8049
Practice Address - Street 1:2470 PRUDEN BLVD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4206
Practice Address - Country:US
Practice Address - Phone:757-922-8046
Practice Address - Fax:757-922-8049
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-30
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170662363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VVC544AMedicare PIN