1568750628 NPI number — LAKESHA TRENELL THOMAS FNP-C

Table of content: LAKESHA TRENELL THOMAS FNP-C (NPI 1568750628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568750628 NPI number — LAKESHA TRENELL THOMAS FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
LAKESHA
Provider Middle Name:
TRENELL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568750628
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 84460
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70884-4460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-526-0018
Provider Business Mailing Address Fax Number:
225-765-9196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4950 ESSEN LN
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70809-3738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-757-0343
Provider Business Practice Location Address Fax Number:
225-757-8354
Provider Enumeration Date:
07/11/2011

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: 363LF0000X , with the licence number:  RN114691-AP06542 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2166166 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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