MEDICARE: LAKETAH LASHAWN HARPER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician	1-112009	AL

General Provider Information

NPI Number	:	1285598201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKETAH LASHAWN HARPER

Provider Business Mailing Address
First Line	:	1801 2ND AVE N APT 207
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-3152
Country	:	US
Telephone Number	:	205-447-3776
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 N GOULD ST STE R
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-6317
Country	:	US
Telephone Number	:	205-597-6099
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2025
Last Update Date	:	12/13/2025

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