Provider Demographics
NPI:1871247288
Name:MCCARGO, LAKERCIA (RN)
Entity type:Individual
Prefix:MRS
First Name:LAKERCIA
Middle Name:
Last Name:MCCARGO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7549 RED HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:PHENIX
Mailing Address - State:VA
Mailing Address - Zip Code:23959-2318
Mailing Address - Country:US
Mailing Address - Phone:434-660-1904
Mailing Address - Fax:
Practice Address - Street 1:7549 RED HOUSE RD
Practice Address - Street 2:
Practice Address - City:PHENIX
Practice Address - State:VA
Practice Address - Zip Code:23959-2318
Practice Address - Country:US
Practice Address - Phone:434-660-1904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-05
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001274870163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty