Provider Demographics
NPI:1235691445
Name:FRANCIS, LA KESHA S (MD)
Entity type:Individual
Prefix:
First Name:LA KESHA
Middle Name:S
Last Name:FRANCIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 N GRAND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-1061
Mailing Address - Country:US
Mailing Address - Phone:520-761-2133
Mailing Address - Fax:520-281-1112
Practice Address - Street 1:1209 W TARGET RANGE RD STE 100
Practice Address - Street 2:
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-2465
Practice Address - Country:US
Practice Address - Phone:520-287-4747
Practice Address - Fax:520-287-4487
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2023-0225207Q00000X
ORMD212329207Q00000X
390200000X
AZ70180207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500811053Medicaid