Provider Demographics
NPI:1851046999
Name:GAINES, LAKIA JANEL
Entity Type:Individual
Prefix:
First Name:LAKIA
Middle Name:JANEL
Last Name:GAINES
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 1:10324 SWEET BAY DR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-7520
Mailing Address - Country:US
Mailing Address - Phone:804-436-2511
Mailing Address - Fax:804-451-4739
Practice Address - Street 1:10324 SWEET BAY DR
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-7520
Practice Address - Country:US
Practice Address - Phone:804-896-6177
Practice Address - Fax:804-451-4739
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1325103247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician