Provider Demographics
NPI:1396297453
Name:TURNER, LAKEITHA HAMBERLIN (FNP-BC)
Entity type:Individual
Prefix:
First Name:LAKEITHA
Middle Name:HAMBERLIN
Last Name:TURNER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:NA
Other - Middle Name:NA
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:405 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:MS
Mailing Address - Zip Code:39069
Mailing Address - Country:US
Mailing Address - Phone:601-786-3475
Mailing Address - Fax:
Practice Address - Street 1:405 MAIN STREET
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MS
Practice Address - Zip Code:39069
Practice Address - Country:US
Practice Address - Phone:601-786-3475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901822363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1396297453Medicare UPIN