MEDICARE: LAKESHA D TABRON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	71017325A	IN

General Provider Information

NPI Number	:	1750177366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKESHA D TABRON

Provider Business Mailing Address
First Line	:	3955 W WASHINGTON CENTER RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-1526
Country	:	US
Telephone Number	:	317-762-8212
Fax Number	:

Provider Business Practice Location Address
First Line	:	3955 W WASHINGTON CENTER RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-1526
Country	:	US
Telephone Number	:	317-762-8212
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2025
Last Update Date	:	01/11/2026

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Directions to “ LAKESHA D TABRON ” Practice Location

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