Healthcare Provider Details

I. General information

NPI: 1891475471
Provider Name (Legal Business Name): LAKECIA BARRETT PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 HEALTHWAY DR STE 140
AURORA IL
60504-8184
US

IV. Provider business mailing address

4050 HEALTHWAY DR STE 140
AURORA IL
60504-8184
US

V. Phone/Fax

Practice location:
  • Phone: 815-409-5117
  • Fax:
Mailing address:
  • Phone: 815-409-5117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209027486
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: