Provider Demographics
NPI:1295960680
Name:TATUM, LAKIA (CRT)
Entity type:Individual
Prefix:MS
First Name:LAKIA
Middle Name:
Last Name:TATUM
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:MS
Other - First Name:LAKIA
Other - Middle Name:
Other - Last Name:CLAYBORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRT
Mailing Address - Street 1:1655 W HORIZON RIDGE PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-3494
Mailing Address - Country:US
Mailing Address - Phone:702-914-2790
Mailing Address - Fax:702-914-5984
Practice Address - Street 1:7324 W CHEYENNE AVE
Practice Address - Street 2:STE 7
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7427
Practice Address - Country:US
Practice Address - Phone:702-214-6665
Practice Address - Fax:702-214-6865
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRC1581227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified