Provider Demographics
NPI:1649867359
Name:YOUNG, LAKESHA CHARMAINE (RN)
Entity type:Individual
Prefix:
First Name:LAKESHA
Middle Name:CHARMAINE
Last Name:YOUNG
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 1:3216 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-4262
Mailing Address - Country:US
Mailing Address - Phone:228-219-5390
Mailing Address - Fax:
Practice Address - Street 1:3216 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-4262
Practice Address - Country:US
Practice Address - Phone:228-219-5390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS878801163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health