Healthcare Provider Details

I. General information

NPI: 1760633986
Provider Name (Legal Business Name): LAKISHA Y MOBLEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 CRESCENT ST STE 2
BROCKTON MA
02302-3453
US

IV. Provider business mailing address

1019 CRESCENT ST STE 2
BROCKTON MA
02302-3453
US

V. Phone/Fax

Practice location:
  • Phone: 781-214-1018
  • Fax:
Mailing address:
  • Phone: 781-214-1018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN268182
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: