Provider Demographics
NPI:1780216143
Name:SMITH, LAKEIDRE BERNASHIA (NP)
Entity type:Individual
Prefix:
First Name:LAKEIDRE
Middle Name:BERNASHIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAKEIDRE
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:500 E FRONT ST STE 160-161
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-7222
Mailing Address - Country:US
Mailing Address - Phone:469-951-0138
Mailing Address - Fax:
Practice Address - Street 1:6800 PRESTON RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2505
Practice Address - Country:US
Practice Address - Phone:469-951-0138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144789363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health