MEDICARE: LAKEISHA SHERRAY STARKES FNP-BC

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	163W00000X	Registered Nurse	RN660837	PA
2	363LF0000X	Family Nurse Practitioner	SP018578	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295225654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKEISHA SHERRAY STARKES FNP-BC

Provider Business Mailing Address
First Line	:	2479 76TH AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-1807
Country	:	US
Telephone Number	:	267-455-5162
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 WASHINGTON AVE UNIT 21C
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-4716
Country	:	US
Telephone Number	:	267-519-9353
Fax Number	:	267-519-8120

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

Provider Enumeration Date	:	05/11/2018
Last Update Date	:	02/15/2019

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