Provider Demographics
NPI:1740164730
Name:BROWN, LAKEISHA JANELLE
Entity type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:JANELLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 BLANKS DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:CLARKTON
Mailing Address - State:NC
Mailing Address - Zip Code:28433-7171
Mailing Address - Country:US
Mailing Address - Phone:910-876-0682
Mailing Address - Fax:
Practice Address - Street 1:102 W 6TH ST
Practice Address - Street 2:
Practice Address - City:TABOR CITY
Practice Address - State:NC
Practice Address - Zip Code:28463-1634
Practice Address - Country:US
Practice Address - Phone:910-876-0682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-02
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)