Provider Demographics
NPI:1447837455
Name:HARRIS, LAKISHA SHENIA (LPN)
Entity type:Individual
Prefix:MS
First Name:LAKISHA
Middle Name:SHENIA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:LAKISHA
Other - Middle Name:SHENIA
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2424 NW 42ND ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-1705
Mailing Address - Country:US
Mailing Address - Phone:580-917-5410
Mailing Address - Fax:
Practice Address - Street 1:1515 NE LAWRIE TATUM RD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507-3002
Practice Address - Country:US
Practice Address - Phone:580-354-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK48007164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse