Provider Demographics
NPI:1932081536
Name:HORTON, LAKEYDRA
Entity type:Individual
Prefix:
First Name:LAKEYDRA
Middle Name:
Last Name:HORTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8206 IVY WOOD CT
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-4401
Mailing Address - Country:US
Mailing Address - Phone:713-933-5295
Mailing Address - Fax:
Practice Address - Street 1:8206 IVY WOOD CT
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-4401
Practice Address - Country:US
Practice Address - Phone:713-933-5295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1005696164X00000X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical Nurse