Provider Demographics
NPI:1750905196
Name:HARPER, LAKYSHA N (CCMA, CPT)
Entity type:Individual
Prefix:
First Name:LAKYSHA
Middle Name:N
Last Name:HARPER
Suffix:
Gender:F
Credentials:CCMA, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1478 BENTLEY CIR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1975
Mailing Address - Country:US
Mailing Address - Phone:850-855-8439
Mailing Address - Fax:
Practice Address - Street 1:1478 BENTLEY CIR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1975
Practice Address - Country:US
Practice Address - Phone:850-855-8439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant