Healthcare Provider Details

I. General information

NPI: 1992668685
Provider Name (Legal Business Name): LAKESHA TAYLOR RN, BSN, CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

3000 TINDLE HILL LN
CHARLOTTE NC
28216-8007
US

IV. Provider business mailing address

3000 TINDLE HILL LN
CHARLOTTE NC
28216-8007
US

V. Phone/Fax

Practice location:
  • Phone: 980-413-0147
  • Fax:
Mailing address:
  • Phone: 980-413-0147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number172968
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: