Provider Demographics
NPI:1710440276
Name:KILLINS, LAMESHA DOUSHETTE
Entity Type:Individual
Prefix:
First Name:LAMESHA
Middle Name:DOUSHETTE
Last Name:KILLINS
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 1:1712 WESTERN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-1932
Mailing Address - Country:US
Mailing Address - Phone:386-265-2802
Mailing Address - Fax:
Practice Address - Street 1:201 THORNBERRY BRANCH LN
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32124-3652
Practice Address - Country:US
Practice Address - Phone:386-872-4892
Practice Address - Fax:386-256-2320
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1649622358OtherCASE MANAGEMENT