Healthcare Provider Details

I. General information

NPI: 1750177366
Provider Name (Legal Business Name): LAKESHA D TABRON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 W WASHINGTON CENTER RD
FORT WAYNE IN
46818-1526
US

IV. Provider business mailing address

1313 W WASHINGTON CENTER RD
FORT WAYNE IN
46825-4142
US

V. Phone/Fax

Practice location:
  • Phone: 317-762-8212
  • Fax:
Mailing address:
  • Phone: 800-342-5653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71017325A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71017325A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: