Provider Demographics
NPI:1528959145
Name:LAKES PSYCHIATRY LLC
Entity type:Organization
Organization Name:LAKES PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:786-404-1575
Mailing Address - Street 1:6303 WATERFORD DISTRICT DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-6040
Mailing Address - Country:US
Mailing Address - Phone:786-404-1575
Mailing Address - Fax:
Practice Address - Street 1:6303 WATERFORD DISTRICT DR STE 400
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-6040
Practice Address - Country:US
Practice Address - Phone:786-404-1575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty