MEDICARE: LAKINA BOUIE

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	251E00000X	Home Health Agency	1000000018189	TN

General Provider Information

NPI Number	:	1508311895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKINA BOUIE

Provider Business Mailing Address
First Line	:	2502 MOUNT MORIAH RD
Second Line	:	A150
City	:	MEMPHIS
State	:	TN
Zip	:	38115-1515
Country	:	US
Telephone Number	:	504-223-4969
Fax Number	:

Provider Business Practice Location Address
First Line	:	2502 MOUNT MORIAH RD
Second Line	:	A150
City	:	MEMPHIS
State	:	TN
Zip	:	38115-1515
Country	:	US
Telephone Number	:	504-223-4969
Fax Number	:

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

Provider Enumeration Date	:	08/17/2016
Last Update Date	:	08/17/2016

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Directions to “ LAKINA BOUIE ” Practice Location

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