MEDICARE: LAKYSHA N HARPER CCMA, CPT

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	3747P1801X	Personal Care Attendant		FL

General Provider Information

NPI Number	:	1750905196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKYSHA N HARPER CCMA, CPT

Provider Business Mailing Address
First Line	:	1478 BENTLEY CIR
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-1975
Country	:	US
Telephone Number	:	850-855-8439
Fax Number	:

Provider Business Practice Location Address
First Line	:	1478 BENTLEY CIR
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-1975
Country	:	US
Telephone Number	:	850-855-8439
Fax Number	:

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

Provider Enumeration Date	:	06/02/2020
Last Update Date	:	06/02/2020

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