1487720405 NPI number — MS. LAKESHIA EVETT COAKLEY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487720405 NPI number — MS. LAKESHIA EVETT COAKLEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COAKLEY
Provider First Name:
LAKESHIA
Provider Middle Name:
EVETT
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COAKLEY
Provider Other First Name:
LAKESHIA
Provider Other Middle Name:
EVETT
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1487720405
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8300 RIVERWIND LN
Provider Second Line Business Mailing Address:
APT 108
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27617-8451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-790-8580
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3125 POPLARWOOD CT
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27604-1084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-790-8580
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1487720405 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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