Provider Demographics
NPI:1629745591
Name:KELLEY-LAVAN, LAKEITHA
Entity Type:Individual
Prefix:
First Name:LAKEITHA
Middle Name:
Last Name:KELLEY-LAVAN
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 1:7501 METCALF AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2927
Mailing Address - Country:US
Mailing Address - Phone:913-642-6330
Mailing Address - Fax:
Practice Address - Street 1:10870 BENSON DR # 216021
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1566
Practice Address - Country:US
Practice Address - Phone:833-357-3227
Practice Address - Fax:855-299-2184
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-80473-071363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily