Provider Demographics
NPI:1720522030
Name:CULKIN-TAYLOR, LAKIETTA (NP)
Entity Type:Individual
Prefix:MRS
First Name:LAKIETTA
Middle Name:
Last Name:CULKIN-TAYLOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4599 BELLEMEADE DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-4924
Mailing Address - Country:US
Mailing Address - Phone:310-292-6299
Mailing Address - Fax:
Practice Address - Street 1:4599 BELLEMEADE DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-4924
Practice Address - Country:US
Practice Address - Phone:310-292-6299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN22252363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care