MEDICARE: LAKISHA PORCH

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	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1598033938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKISHA PORCH

Provider Business Mailing Address
First Line	:	1548 MITCHELL AVE
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76708-2965
Country	:	US
Telephone Number	:	254-349-1214
Fax Number	:

Provider Business Practice Location Address
First Line	:	1548 MITCHELL AVE
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76708-2965
Country	:	US
Telephone Number	:	254-349-1214
Fax Number	:

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

Provider Enumeration Date	:	12/13/2011
Last Update Date	:	12/13/2011

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Directions to “ LAKISHA PORCH ” Practice Location

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