Healthcare Provider Details

I. General information

NPI: 1154106508
Provider Name (Legal Business Name): LEKISHA CAPRICE PRIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 HIGHWAY 6 E
BATESVILLE MS
38606-3000
US

IV. Provider business mailing address

1221 HARMON RD
BATESVILLE MS
38606-8630
US

V. Phone/Fax

Practice location:
  • Phone: 662-547-8159
  • Fax: 662-214-6098
Mailing address:
  • Phone: 662-614-7606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number906205
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number34596
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number906205
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number34596
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0024190179
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: