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General NPI Number Information
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NPI Number | 1881505915
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Entity Type | Individual
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Provider Name | LAKEESHA JACKSON
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Gender | Female
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Dates
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Enumeration Date | 09/16/2026
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Last Update Date | 09/16/2026
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Provider Practice Location Address
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Address Line | 7607 W TOWNSEND ST STE 108
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City | MILWAUKEE
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State | WI
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Zip | 53222-3965
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Country | US
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Telephone | 414-803-8934
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Fax | 414-539-1800
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Provider Business Mailing Address
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Address Line | 9715 W LOLITA AVE
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City | MILWAUKEE
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State | WI
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Zip | 53224-3350
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Country | US
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Telephone | 414-803-8934
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Fax | 414-539-1800
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 19147-33
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License Number State | WI
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