Basic Information
| Provider Information | |||||||||
| NPI: | 1578063731 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAKEY | ||||||||
| FirstName: | KITTY | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LM, CPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 LITHIA PINECREST RD | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335115307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136858404 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 215 LITHIA PINECREST RD | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335115307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136858404 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2018 | ||||||||
| LastUpdateDate: | 02/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | MW358 | FL | Y | Other Service Providers | Midwife |
No ID Information.