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General NPI Number Information
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NPI Number | 1578837126
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Entity Type | Individual
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Provider Name | LAKEITHA CAMP
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Gender | Female
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Dates
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Enumeration Date | 02/29/2012
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Last Update Date | 03/09/2012
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Provider Practice Location Address
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Address Line | 1130 E SEMINARY DR # B
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City | FORT WORTH
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State | TX
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Zip | 76115-2830
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Country | US
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Telephone | 817-922-9619
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Fax |
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Provider Business Mailing Address
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Address Line | 4521 MALLOW OAK DR
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City | FORT WORTH
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State | TX
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Zip | 76123-2754
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Country | US
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Telephone | 469-531-3531
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number |
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License Number State | TX
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