Healthcare Provider Details

I. General information

NPI: 1891237889
Provider Name (Legal Business Name): LAKIESHA SHEAFFER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3132 STATE ST STE 104
MEDFORD OR
97504-8688
US

IV. Provider business mailing address

3132 STATE ST STE 104
MEDFORD OR
97504-8688
US

V. Phone/Fax

Practice location:
  • Phone: 541-414-0481
  • Fax:
Mailing address:
  • Phone: 541-414-0481
  • Fax: 541-414-0482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9494253
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201608321NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: