Provider Demographics
NPI:1053014266
Name:KIMBLE, LAKESHA (RN)
Entity type:Individual
Prefix:
First Name:LAKESHA
Middle Name:
Last Name:KIMBLE
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 1:5906 GA HIGHWAY 39
Mailing Address - Street 2:
Mailing Address - City:DONALSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:39845-6122
Mailing Address - Country:US
Mailing Address - Phone:800-977-2186
Mailing Address - Fax:912-387-4547
Practice Address - Street 1:5906 GA HIGHWAY 39
Practice Address - Street 2:
Practice Address - City:DONALSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:39845-6122
Practice Address - Country:US
Practice Address - Phone:800-977-2186
Practice Address - Fax:912-387-4547
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN317825163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health