Healthcare Provider Details

I. General information

NPI: 1740073527
Provider Name (Legal Business Name): LAKEISHA A BEDFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2025
Last Update Date: 05/26/2025
Certification Date: 05/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N IH 35 STE 315 PMB 3249
ROUND ROCK TX
78681
US

IV. Provider business mailing address

110 N IH 35 STE 315 PMB 3249
ROUND ROCK TX
78681
US

V. Phone/Fax

Practice location:
  • Phone: 737-328-6194
  • Fax:
Mailing address:
  • Phone: 737-328-6194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberD9LIFMPEU6
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD9LIFMPEU6
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberD9LIFMPEU6
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License NumberD9LIFMPEU6
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: