Provider Demographics
NPI:1356581490
Name:ROPER, LACARSHIA TEESHANTAL (RN)
Entity type:Individual
Prefix:MRS
First Name:LACARSHIA
Middle Name:TEESHANTAL
Last Name:ROPER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2513 WATER OAK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-6868
Mailing Address - Country:US
Mailing Address - Phone:706-561-6559
Mailing Address - Fax:
Practice Address - Street 1:2513 WATER OAK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-6868
Practice Address - Country:US
Practice Address - Phone:706-561-6559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN180532163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse