Provider Demographics
NPI:1023838448
Name:KILPATRICK, LAKYSHA ANN
Entity type:Individual
Prefix:
First Name:LAKYSHA
Middle Name:ANN
Last Name:KILPATRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAKYSHA
Other - Middle Name:ANN
Other - Last Name:KILPATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1533 LEWIS ST OFC 312
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-4092
Mailing Address - Country:US
Mailing Address - Phone:317-473-1565
Mailing Address - Fax:
Practice Address - Street 1:1533 LEWIS ST OFC 312
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-4092
Practice Address - Country:US
Practice Address - Phone:317-473-1565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
24-017382253Z00000X
253Z00000X
IN24-017382253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care