Healthcare Provider Details

I. General information

NPI: 1962204297
Provider Name (Legal Business Name): LAKESHA CUNNINGHAM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAKESHA ESTIEN

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8820 COLUMBIA 100 PKWY STE 430
COLUMBIA MD
21045-2175
US

IV. Provider business mailing address

14317 SAMOA ST
FISHERS IN
46038-5289
US

V. Phone/Fax

Practice location:
  • Phone: 317-792-6681
  • Fax:
Mailing address:
  • Phone: 317-258-5199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71016755A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: