Healthcare Provider Details

I. General information

NPI: 1528870011
Provider Name (Legal Business Name): LAKEESHA HOUSTON NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 HUMBER ST
MEMPHIS TN
38106-5433
US

IV. Provider business mailing address

1623 HUMBER ST
MEMPHIS TN
38106-5433
US

V. Phone/Fax

Practice location:
  • Phone: 901-270-9885
  • Fax:
Mailing address:
  • Phone: 901-270-9885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number257315
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number38023
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: