Healthcare Provider Details

I. General information

NPI: 1841045341
Provider Name (Legal Business Name): LAKISHA MCDONALD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1583 HEALTH CARE DR
ROCK HILL SC
29732-3858
US

IV. Provider business mailing address

3004 PARKER GREEN TRL
CHARLOTTE NC
28269-1490
US

V. Phone/Fax

Practice location:
  • Phone: 803-329-7772
  • Fax: 803-329-9821
Mailing address:
  • Phone: 704-615-7829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number190429
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number28951
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: