Healthcare Provider Details

I. General information

NPI: 1285598201
Provider Name (Legal Business Name): LAKETAH LASHAWN HARPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2025
Last Update Date: 12/13/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N GOULD ST STE R
SHERIDAN WY
82801-6317
US

IV. Provider business mailing address

1801 2ND AVE N APT 207
BIRMINGHAM AL
35203-3152
US

V. Phone/Fax

Practice location:
  • Phone: 205-597-6099
  • Fax:
Mailing address:
  • Phone: 205-447-3776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number1-112009
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: