Provider Demographics
NPI:1902125610
Name:ELLIOTT, LEKESHIA TESHAMBIE (COSMETOLOGY)
Entity Type:Individual
Prefix:MRS
First Name:LEKESHIA
Middle Name:TESHAMBIE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:COSMETOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 TARBORO ST SW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3555
Mailing Address - Country:US
Mailing Address - Phone:252-234-6086
Mailing Address - Fax:
Practice Address - Street 1:1211 TARBORO ST SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3555
Practice Address - Country:US
Practice Address - Phone:252-234-6086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC52058332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies