Provider Demographics
NPI:1730680299
Name:WOODS, LAKETA SHAVONNE (LVN)
Entity Type:Individual
Prefix:
First Name:LAKETA
Middle Name:SHAVONNE
Last Name:WOODS
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 1:1109 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-7515
Mailing Address - Country:US
Mailing Address - Phone:903-651-1479
Mailing Address - Fax:
Practice Address - Street 1:1109 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-7515
Practice Address - Country:US
Practice Address - Phone:903-651-1479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300587164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse