Healthcare Provider Details

I. General information

NPI: 1972266443
Provider Name (Legal Business Name): LAKEISHA M HUNT BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5932 HICKORY TRACE CV
MEMPHIS TN
38141-7646
US

IV. Provider business mailing address

6025 STAGE RD STE 42-426
BARTLETT TN
38134-8374
US

V. Phone/Fax

Practice location:
  • Phone: 901-690-8408
  • Fax:
Mailing address:
  • Phone: 901-415-9889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number00205338
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number00205338
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number00205338
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: