Provider Demographics
NPI:1831455864
Name:LUCAS, LA'KEYA TA'NAE
Entity type:Individual
Prefix:MISS
First Name:LA'KEYA
Middle Name:TA'NAE
Last Name:LUCAS
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 1:4417 NW 18TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-3629
Mailing Address - Country:US
Mailing Address - Phone:405-837-4603
Mailing Address - Fax:888-505-8830
Practice Address - Street 1:4417 NW 18TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-3629
Practice Address - Country:US
Practice Address - Phone:405-837-4603
Practice Address - Fax:888-505-8830
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator