=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396513214
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAKEISHA LAVERNE WALKER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2023
-----------------------------------------------------
Last Update Date | 12/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9249 GARRETT LAKE DR
-----------------------------------------------------
City | MIDLAND
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31820-4447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-662-4083
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9249 GARRETT LAKE DR
-----------------------------------------------------
City | MIDLAND
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31820-4447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-662-4083
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251F00000X
-----------------------------------------------------
Taxonomy Name | Home Infusion Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------
Taxonomy #8
-----------------------------------------------------
Taxonomy Code | 163WH0200X
-----------------------------------------------------
Taxonomy Name | Home Health Registered Nurse
-----------------------------------------------------
License Number | RN265156
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #9
-----------------------------------------------------
Taxonomy Code | 163WH1000X
-----------------------------------------------------
Taxonomy Name | Hospice Registered Nurse
-----------------------------------------------------
License Number | RN265156
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #10
-----------------------------------------------------
Taxonomy Code | 163WI0500X
-----------------------------------------------------
Taxonomy Name | Infusion Therapy Registered Nurse
-----------------------------------------------------
License Number | RN265156
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #11
-----------------------------------------------------
Taxonomy Code | 163WW0000X
-----------------------------------------------------
Taxonomy Name | Wound Care Registered Nurse
-----------------------------------------------------
License Number | RN265156
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #12
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------