Healthcare Provider Details

I. General information

NPI: 1265232714
Provider Name (Legal Business Name): LAKISHA S ESKRIDGE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W 6TH AVE
GARY IN
46402-1711
US

IV. Provider business mailing address

1100 W 6TH AVE
GARY IN
46402-1711
US

V. Phone/Fax

Practice location:
  • Phone: 219-885-4264
  • Fax:
Mailing address:
  • Phone: 219-689-3588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number28230889A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: