Healthcare Provider Details

I. General information

NPI: 1992640072
Provider Name (Legal Business Name): LAKEISA KEMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 KITE RD
SWAINSBORO GA
30401-5771
US

IV. Provider business mailing address

305 KITE RD
SWAINSBORO GA
30401-5771
US

V. Phone/Fax

Practice location:
  • Phone: 478-237-7517
  • Fax:
Mailing address:
  • Phone: 478-237-7517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP240203
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: