Provider Demographics
NPI:1851016315
Name:HICKS, LAKEYSHA DANYEAL
Entity Type:Individual
Prefix:MS
First Name:LAKEYSHA
Middle Name:DANYEAL
Last Name:HICKS
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 1:2705 OLD YELLOW SPRINGS RD APT 101
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-2652
Mailing Address - Country:US
Mailing Address - Phone:937-397-1543
Mailing Address - Fax:
Practice Address - Street 1:2705 OLD YELLOW SPRINGS RD APT 101
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-2652
Practice Address - Country:US
Practice Address - Phone:937-397-1543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker