Provider Demographics
NPI:1881201994
Name:TUCKER, LAKENDRA CHARISSE
Entity Type:Individual
Prefix:
First Name:LAKENDRA
Middle Name:CHARISSE
Last Name:TUCKER
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 1:1706 BENTLEY CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-3600
Mailing Address - Country:US
Mailing Address - Phone:803-543-6445
Mailing Address - Fax:
Practice Address - Street 1:1706 BENTLEY CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-3600
Practice Address - Country:US
Practice Address - Phone:803-543-6445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide