=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962204297
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAKESHA CUNNINGHAM FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2025
-----------------------------------------------------
Last Update Date | 08/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8820 COLUMBIA 100 PKWY STE 430
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21045-2175
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-792-6681
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14317 SAMOA ST
-----------------------------------------------------
City | FISHERS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46038-5289
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-258-5199
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 71016755A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------