Healthcare Provider Details

I. General information

NPI: 1831898196
Provider Name (Legal Business Name): THE LUMPKIN ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8879 W FLAMINGO RD STE 102
LAS VEGAS NV
89147-8732
US

IV. Provider business mailing address

2812 DESERT ZINNIA LN
LAS VEGAS NV
89135-2002
US

V. Phone/Fax

Practice location:
  • Phone: 951-385-1741
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MONIQUE LUMPKIN
Title or Position: PRESIDENT
Credential:
Phone: 951-385-1741