Provider Demographics
NPI:1831661800
Name:REDMOND, LAKISHA (RMA, CCMA, AHI, PBT)
Entity Type:Individual
Prefix:
First Name:LAKISHA
Middle Name:
Last Name:REDMOND
Suffix:
Gender:F
Credentials:RMA, CCMA, AHI, PBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12320 ASHLEY DR
Mailing Address - Street 2:STE D
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503
Mailing Address - Country:US
Mailing Address - Phone:228-609-9752
Mailing Address - Fax:888-964-2655
Practice Address - Street 1:12320 ASHLEY DR
Practice Address - Street 2:STE D
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503
Practice Address - Country:US
Practice Address - Phone:228-609-9752
Practice Address - Fax:888-964-2655
Is Sole Proprietor?:No
Enumeration Date:2019-01-01
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2591601202C00000X, 247ZC0005X
MS65804246RP1900X
MS25475911246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory